Provider Demographics
NPI:1972559607
Name:CHOUINARD, ANNE M (PAC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:MACNICHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:4 ELLIOT WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3551
Practice Address - Country:US
Practice Address - Phone:603-626-5900
Practice Address - Fax:603-625-2180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP0593Medicare ID - Type Unspecified