Basic Information
| Provider Information | |||||||||
| NPI: | 1952668030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZINNER | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | KRISTIN | ||||||||
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| Credential: | RN, NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036635310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036262626 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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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 | 363LN0000X | 697370 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 363LN0000X | RN2276287 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 363L00000X | 065860-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 30349757 | 05 | NH | MEDICAID |