Basic Information
| Provider Information | |||||||||
| NPI: | 1437111606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LA REE | ||||||||
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| Credential: | MS CS ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 789 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037429200 | ||||||||
| FaxNumber: | 6037424605 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 MEMBERS WAY | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038205933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037429200 | ||||||||
| FaxNumber: | 6037424605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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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 | 163WP0807X | 589 | NH | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | 3074048 | 05 | NH | MEDICAID | 7135879 | 01 | AETNA | OTHER | 2023607 | 01 | NH | CIGNA | OTHER | 4009533YONH01 | 01 | NH | BCBS | OTHER |