Basic Information
Provider Information
NPI: 1801380720
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHROSBREE
FirstName: EMILY
MiddleName: J
NamePrefix: MS.
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 ALICE PECK DAY DR
Address2:  
City: LEBANON
State: NH
PostalCode: 03766
CountryCode: US
TelephoneNumber: 6034483121
FaxNumber:  
Practice Location
Address1: 10 ALICE PECK DAY DR
Address2:  
City: LEBANON
State: NH
PostalCode: 03766
CountryCode: US
TelephoneNumber: 6034483121
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2018
LastUpdateDate: 04/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004X239027NCN Allopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
363A00000X0010-08142NCN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X239027NCN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X1815NHY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


Home