Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0304962304 | NH |
NPI | 1043379837 |
---|---|
Provider Name | Christine Clyne |
First Address | Conway, NH 03818-2800 |
Second Address | Conway, NH 03818-4204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1329904 | AETNA (01) | |
30341074 | (05) | NH |
4008336Y0NH01 | ANTHEM BC (01) | NH |
4710482 | CIGNA (01) | |
AA58958 | HARVARD PILGRIM (01) |