Healthcare Provider Details

I. General information

NPI: 1487771895
Provider Name (Legal Business Name): BRENDA M SANBORN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TARRYTOWN RD
MANCHESTER NH
03103-2713
US

IV. Provider business mailing address

150 TARRYTOWN ROAD
MANCHESTER NH
03103-2713
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3162
  • Fax: 603-622-8677
Mailing address:
  • Phone: 603-622-3162
  • Fax: 603-622-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number020455-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: