Basic Information
| Provider Information | |||||||||
| NPI: | 1477132538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUACKENBUSH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036269500 | ||||||||
| FaxNumber: | 6036269523 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036269500 | ||||||||
| FaxNumber: | 6039359523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2021 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2303975 | MA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | RN2303975 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 073337-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.