Individual
MARY CROASDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 W MAIN ST, CONWAY, NH 03818-6142
(603) 447-2111
Mailing address
87 WASHINGTON ST, CONWAY, NH 03818-6044
(603) 447-3347
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706638Y0NH01
ANTHEM
NH
05
—
81263824
—
NH
Enumeration date
09/15/2008
Last updated
09/15/2008
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