Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 16391 | NH |
NPI | 1083720858 |
---|---|
Provider Name | Elizabeth Sailhamer Soukup |
First Address | Manchester, NH 03103-3502 |
Second Address | Manchester, NH 03103-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 02/04/2014 |