Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 042725-23 | NH |
NPI | 1033169115 |
---|---|
Provider Name | Ms. Wilma Arleen Hyde |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03756-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 06/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30010015 | (05) | NH |
P21826 | (02) |