Provider Demographics
NPI:1538871496
Name:MANDEVILLE, JOHN L (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:MANDEVILLE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 STATE ROUTE 101 UNIT 2
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1706
Mailing Address - Country:US
Mailing Address - Phone:603-693-2100
Mailing Address - Fax:603-679-1046
Practice Address - Street 1:282 STATE ROUTE 101 UNIT 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1706
Practice Address - Country:US
Practice Address - Phone:603-693-2100
Practice Address - Fax:603-679-1046
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH079027-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily