Basic Information
| Provider Information | |||||||||
| NPI: | 1114905361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRSCHFELD | ||||||||
| FirstName: | CHARISSE | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2540 | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038602540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038605111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565472 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2006 | ||||||||
| LastUpdateDate: | 04/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 032231-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0173511 | 05 | NH | MEDICAID | 40Y008796NH01 | 01 | NH | ANTHEM | OTHER | 30343936 | 05 | NH | MEDICAID |