Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1275 | NH |
Y | 213ES0000X | Sports Medicine | 1275 | NH |
NPI | 1558862292 |
---|---|
Provider Name | Miss Jennifer Gaudet |
First Address | Nashua, NH 03060-5093 |
Second Address | Manchester, NH 03101-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 27/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2394460 | PROLIABILITY (01) |