Provider Demographics
NPI:1558161943
Name:GAUDET, ELLYN WHELAN (APRN)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:WHELAN
Last Name:GAUDET
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2703
Mailing Address - Country:US
Mailing Address - Phone:603-812-1535
Mailing Address - Fax:
Practice Address - Street 1:36 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2359
Practice Address - Country:US
Practice Address - Phone:603-271-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH073787-21163W00000X
NH073787-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse