Basic Information
| Provider Information | |||||||||
| NPI: | 1760621056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOJTKO | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | GALEN | ||||||||
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| Credential: | MS, MSNA, APRN-CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CHARRON CIR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038331806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036677333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 ALUMNI DR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035806624 | ||||||||
| FaxNumber: | 6035806620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 052326-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 3100526 | 05 | NH | MEDICAID |