Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 086329-21 | NH |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 050174-23 | NH |
NPI | 1073288833 |
---|---|
Provider Name | Cecelia V Brelsford |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03756-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 04/11/2021 |