Basic Information
| Provider Information | |||||||||
| NPI: | 1851379002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIGEANT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5001 | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038605001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038605111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | 0493542305 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 30343032 | 05 | NH | MEDICAID |