Basic Information
Provider Information | |||||||||
NPI: | 1780851220 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HEPLER | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | JEAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STOREY | ||||||||
OtherFirstName: | AMANDA | ||||||||
OtherMiddleName: | JEAN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | LEBANON | ||||||||
State: | NH | ||||||||
PostalCode: | 037561000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036505000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | LEBANON | ||||||||
State: | NH | ||||||||
PostalCode: | 037561000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036505000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/14/2008 | ||||||||
LastUpdateDate: | 04/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/02/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207Q00000X | 017845 | PA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 042-0012824 | VT | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 15796 | NH | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 432996399 | 05 | ME |   | MEDICAID | 3077616 | 05 | NH |   | MEDICAID |