Healthcare Provider Details

I. General information

NPI: 1194364083
Provider Name (Legal Business Name): CRANMORE HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 04/08/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 US RTE 302 UNIT 1
GLEN NH
03838-6300
US

IV. Provider business mailing address

PO BOX 125
CENTER CONWAY NH
03813-0125
US

V. Phone/Fax

Practice location:
  • Phone: 603-730-5356
  • Fax:
Mailing address:
  • Phone: 603-387-4523
  • Fax: 603-369-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY C DEFEO
Title or Position: PARTNER
Credential: CRNA, FNP
Phone: 603-387-4523