Active NPI
Vicki Tanner Petalas, FNP
- Family Nurse Practitioner
- Somersworth, NH
National Provider Identifier
1275197741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 049901-23
- Practice address
- 255 Route 108
Somersworth, NH 03878-1543 - Phone
- (603) 841-2301
- Fax
- (603) 692-1081
- NPI assigned
- Apr 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 049901-23 | NH | Primary |
Addresses
Primary practice location
255 Route 108
Somersworth, NH 03878-1543
Mailing address
300 Southborough Dr
South Portland, ME 04106-6914
Other practice location 1
2299 Woodbury Ave
Newington, NH 03801-7854
Phone (603) 766-8660
Other practice location 2
300 Southborough Dr
South Portland, ME 04106-6914
Phone (603) 777-2650
Other names 1
- Ms. Vicki Anne Tanner
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049901-23 | NH | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564099200000",
"number": "1275197741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 SOUTHBOROUGH DR",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041066914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 ROUTE 108",
"city": "SOMERSWORTH",
"state": "NH",
"postal_code": "038781543",
"telephone_number": "603-841-2301",
"fax_number": "603-692-1081"
}
],
"practiceLocations": [
{
"address_1": "2299 Woodbury Ave",
"address_purpose": "LOCATION",
"city": "Newington",
"state": "NH",
"postal_code": "038017854",
"country_code": "US",
"telephone_number": "603-766-8660",
"fax_number": "603-766-8661",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Southborough Dr",
"address_purpose": "LOCATION",
"city": "South Portland",
"state": "ME",
"postal_code": "041066914",
"country_code": "US",
"telephone_number": "603-777-2650",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETALAS",
"first_name": "VICKI",
"middle_name": "TANNER",
"name_prefix": "Mrs.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-30",
"last_updated": "2019-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NH",
"license": "049901-23",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "VICKI",
"last_name": "TANNER",
"middle_name": "ANNE",
"prefix": "MS.",
"credential": "RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Somersworth, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.