Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 074620-23 | NH |
N | 363LG0600X | Nurse Practitioner - Gerontology | 074620-23 | NH |
NPI | 1033692850 |
---|---|
Provider Name | Ms. Alexa Ruppert Holleran |
First Address | Lebanon, NH 03766-2900 |
Second Address | Lebanon, NH 03766-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |