Healthcare Provider Details

I. General information

NPI: 1487670402
Provider Name (Legal Business Name): SANDRA L BRISTOL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 N MAIN ST
CONCORD NH
03301-5046
US

IV. Provider business mailing address

189 N MAIN ST
CONCORD NH
03301-5046
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1111
  • Fax: 603-226-4314
Mailing address:
  • Phone: 603-228-1111
  • Fax: 603-226-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number024772304
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: