Healthcare Provider Details

I. General information

NPI: 1427002740
Provider Name (Legal Business Name): RACHEL LYNN WYNINEGAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LYNN FREDERICK APRN

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SOUTH RIVER ROAD ORTHOPAEDICS/PODIATRY
BEDFORD NH
03110
US

IV. Provider business mailing address

25 S RIVER RD
BEDFORD NH
03110-6708
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2998
  • Fax:
Mailing address:
  • Phone: 603-695-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number065451-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number258927
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number065451-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: