Basic Information
Provider Information
NPI: 1477503159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCINALLY
FirstName: HEIDI
MiddleName: SNOW
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 40 PHEASANT LN
Address2:  
City: HAMPSTEAD
State: NH
PostalCode: 038412388
CountryCode: US
TelephoneNumber: 6033295823
FaxNumber:  
Practice Location
Address1: 718 SMYTH RD
Address2:  
City: MANCHESTER
State: NH
PostalCode: 031047004
CountryCode: US
TelephoneNumber: 6036244366
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X030554-23-05NHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


Home