Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 059863-23 | NH |
NPI | 1033753520 |
---|---|
Provider Name | Kim Ann Eldredge |
First Address | Pelham, NH 03076-2202 |
Second Address | Concord, NH 03301-5004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |