Healthcare Provider Details

I. General information

NPI: 1508515487
Provider Name (Legal Business Name): KRYSTLE LYNN LINNANE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LOUDON RD
CONCORD NH
03301-5300
US

IV. Provider business mailing address

111 NH AVE STE 2
PORTSMOUTH NH
03801-2864
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-9000
  • Fax:
Mailing address:
  • Phone: 603-319-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number061394-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: