Healthcare Provider Details

I. General information

NPI: 1659113181
Provider Name (Legal Business Name): MARLENA KITTELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1729
US

IV. Provider business mailing address

51 CRAM RD
WEARE NH
03281-5604
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number082096-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: