Basic Information
| Provider Information | |||||||||
| NPI: | 1881318566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORTIN | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | MOUNTAHA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN, APRN, ACNPC-AG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 BODWELL RD UNIT 27 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031095870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033597893 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 250 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032252711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2022 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 068254-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.