Healthcare Provider Details

I. General information

NPI: 1972523868
Provider Name (Legal Business Name): JOANNE SANDBERG-COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LYME RD
HANOVER NH
03755-1225
US

IV. Provider business mailing address

80 LYME RD
HANOVER NH
03755-1225
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-8525
  • Fax: 603-653-8697
Mailing address:
  • Phone: 603-653-8525
  • Fax: 603-653-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number04072723
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: