Healthcare Provider Details

I. General information

NPI: 1366141665
Provider Name (Legal Business Name): KENNETH YEOMANS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ESTATE DR
MANCHESTER NH
03104-4034
US

IV. Provider business mailing address

7 ESTATE DR
MANCHESTER NH
03104-4034
US

V. Phone/Fax

Practice location:
  • Phone: 603-932-9044
  • Fax:
Mailing address:
  • Phone: 603-932-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2351768
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: