Basic Information
| Provider Information | |||||||||
| NPI: | 1124463096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRVING | ||||||||
| FirstName: | SADIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 76 | ||||||||
| Address2: | |||||||||
| City: | CENTER BARNSTEAD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032250076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032902657 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15 OLD ROLLINSFORD RD STE 302 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037429200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2013 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 073975-21 | NH | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 073975-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3127919 | 05 | NH | MEDICAID |