Provider Demographics
NPI:1568457083
Name:PADUA, NELLY (NP)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:PADUA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1835
Mailing Address - Country:US
Mailing Address - Phone:603-883-1626
Mailing Address - Fax:978-683-0663
Practice Address - Street 1:22 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3924
Practice Address - Country:US
Practice Address - Phone:036-883-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH112096-23363LF0000X
MA207263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303775Medicaid
MA1303775Medicaid
MANP3628Medicare ID - Type Unspecified