Doctor Name: | LAURA MATJASICH |
NPI Number: | 1265849350 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 5673235-4405 |
Business Practice Address: | 27 Londonderry Tpke Hooksett, NH - 031062012 |
Business Phone Number: | 6033145980 |
Business Fax Number: | |
Mailing Address: | 27 Londonderry Turnkpike Bypass 28, HOOKSETT |
State: | NH |
Postal Code: | 03106 |
Phone Number: | 6033145980 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2014 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5673235-4405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |