Provider Demographics
NPI:1699366906
Name:VITTUM, ASHLEY (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VITTUM
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 1:24 BRIDGE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4922
Mailing Address - Country:US
Mailing Address - Phone:603-415-0090
Mailing Address - Fax:833-944-2250
Practice Address - Street 1:24 BRIDGE ST STE 9
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4922
Practice Address - Country:US
Practice Address - Phone:603-415-0090
Practice Address - Fax:833-944-2250
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH069682-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3126952Medicaid