Provider Demographics
NPI:1215700174
Name:ANDERSON, MARY ISABELLE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ISABELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MERRIAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03048-3300
Mailing Address - Country:US
Mailing Address - Phone:603-213-1189
Mailing Address - Fax:
Practice Address - Street 1:72 MERRIAM HILL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NH
Practice Address - Zip Code:03048-3300
Practice Address - Country:US
Practice Address - Phone:603-213-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health