Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 16259 | NH |
N | 207N00000X | Dermatologist | 17621 | PR |
NPI | 1003015173 |
---|---|
Provider Name | Dr. Mayra Beauchamp Bruno |
First Address | Concord, NH 03301-7560 |
Second Address | Concord, NH 03301-7560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3091082 | (05) | NH |