Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 60846 | TN |
NPI | 1003349002 |
---|---|
Provider Name | Dr. Nicolette Alexandria Metrusias |
First Address | Laconia, NH 03246-3235 |
Second Address | Laconia, NH 03246-3235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 29/06/2021 |