MEDICARE: WILLOW BROOK FAMILY PRACTICE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1356126601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW BROOK FAMILY PRACTICE PLLC

Provider Business Mailing Address
First Line	:	412 WILLOW BROOK RD
Second Line	:
City	:	PLAINFIELD
State	:	NH
Zip	:	03781-5209
Country	:	US
Telephone Number	:	603-469-2055
Fax Number	:	603-469-2044

Provider Business Practice Location Address
First Line	:	7 CAMPUS CENTER DR
Second Line	:
City	:	MERIDEN
State	:	NH
Zip	:	03770-5402
Country	:	US
Telephone Number	:	603-469-2055
Fax Number	:	603-469-2044

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA UNDERHILL
Credential	:
Telephone Number	:	603-469-2055

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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