Provider Demographics
NPI:1902902075
Name:MOHAN, DONNA (ARNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MONT VERNON RD.
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070
Mailing Address - Country:US
Mailing Address - Phone:603-897-5485
Mailing Address - Fax:
Practice Address - Street 1:170 COMMERCE WAY STE 103
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3272
Practice Address - Country:US
Practice Address - Phone:603-897-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039386-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0841OtherMEDICARE PTAN
NH30009982Medicaid
NH30009982Medicaid