Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 050227-23-03 | NH |
NPI | 1013015858 |
---|---|
Provider Name | Jill Capobianco |
First Address | Portsmouth, NH 03801-5892 |
Second Address | Portsmouth, NH 03801-5892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30342327 | (05) | NH |
Q33943 | (02) |