Doctor Name: | KERRY MARIE LOAN |
NPI Number: | 1275886467 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA4472 |
Business Practice Address: | 21 Clark Way Somersworth, NH - 038784401 |
Business Phone Number: | 6036922228 |
Business Fax Number: | |
Mailing Address: | 21 Clark Way, SOMERSWORTH |
State: | NH |
Postal Code: | 038784401 |
Phone Number: | 6036922228 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2012 |
NPI Last Update Date: | 04/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA4472 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |