Basic Information
| Provider Information | |||||||||
| NPI: | 1992866016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AINSWORTH QUINTAL | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 NEW HAMPSHIRE AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034106700 | ||||||||
| FaxNumber: | 6033198308 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035783347 | ||||||||
| FaxNumber: | 6035783387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 024479-21 | NH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 024479-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0711764 | 05 | MA | MEDICAID | 30203623 | 05 | NH | MEDICAID | 4007048Y0NH04 | 01 | NH | ANTHEM | OTHER |