Individual
MISS SHANNA M BORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
800 TURNPIKE RD, NEW IPSWICH, NH 03071
(360) 687-2701
Mailing address
PO BOX 314, JAFFREY, NH 03452-0314
(360) 852-3928
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3591M
NH
171W00000X
Contractor
MA60043680
WA
Other
Enumeration date
03/04/2010
Last updated
02/04/2014
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