Healthcare Provider Details

I. General information

NPI: 1215344528
Provider Name (Legal Business Name): KELSEY TWEED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MECHANIC ST SUITE 360
LEBANON NH
03766-1537
US

IV. Provider business mailing address

9 HANOVER ST SUITE 2
LEBANON NH
03766-1312
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-1101
  • Fax: 603-448-8249
Mailing address:
  • Phone: 603-448-0126
  • Fax: 603-448-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: