Provider Demographics
NPI:1639103229
Name:LANDON, CAROL A (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:LANDON
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 1:456 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3699
Mailing Address - Country:US
Mailing Address - Phone:603-424-8120
Mailing Address - Fax:603-424-8140
Practice Address - Street 1:454 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3695
Practice Address - Country:US
Practice Address - Phone:603-424-8120
Practice Address - Fax:603-424-8140
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0246942303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30D0084963OtherCLIA ID #
NH50Y095600NH01OtherBC/BS GROUP ID #
020451281OtherTAX ID #
NH23YP02407NH01OtherBC/BS IPN
NH0246942303OtherBON LIC #
NH0246942303OtherBON LIC #
NHML0528755OtherDEA
P61715Medicare UPIN