Provider Demographics
NPI:1962203596
Name:STATE OF NEW HAMPSHIRE
Entity type:Organization
Organization Name:STATE OF NEW HAMPSHIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGDELINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-665-1580
Mailing Address - Street 1:1056 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-1958
Mailing Address - Country:US
Mailing Address - Phone:603-665-1580
Mailing Address - Fax:603-668-4143
Practice Address - Street 1:1056 RIVER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-1958
Practice Address - Country:US
Practice Address - Phone:603-665-1580
Practice Address - Fax:603-668-4143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW HAMPSHIRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty