Basic Information
| Provider Information | |||||||||
| NPI: | 1326043902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENZ-ARMSTRONG | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32 | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032160032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1095 PROFILE RD | ||||||||
| Address2: | |||||||||
| City: | FRANCONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035804938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 01/20/2011 | ||||||||
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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 | 363AS0400X | 0443 P | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 30333057 | 05 | NH | MEDICAID | P00476754 | 01 | NH | RAIL ROAD MEDICARE | OTHER |