Healthcare Provider Details

I. General information

NPI: 1528067501
Provider Name (Legal Business Name): KIMBERLY ANNE ROULEAU ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KIMBERLY ANNE ROULEAU ARNP

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 RIVERWAY PL
BEDFORD NH
03110-6768
US

IV. Provider business mailing address

706 RIVERWAY PL
BEDFORD NH
03110-6768
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-3516
  • Fax: 603-623-3580
Mailing address:
  • Phone: 603-623-3516
  • Fax: 603-623-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number041762-23-05
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: