Individual
JEREMY M PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 ELLIOT WAY, MANCHESTER, NH 03103-3502
(603) 663-2830
(603) 663-1849
Mailing address
1 ELLIOT WAY, MANCHESTER, NH 03103-3502
(603) 663-2830
(603) 663-1849
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1333
NH
Other
Enumeration date
02/26/2018
Last updated
09/27/2019
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