Healthcare Provider Details

I. General information

NPI: 1063147726
Provider Name (Legal Business Name): ISABELLE WILDER HOLDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 NASHUA ST
MILFORD NH
03055-4915
US

IV. Provider business mailing address

904 TOWNSEND RD
GROTON MA
01450-1104
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-3870
  • Fax:
Mailing address:
  • Phone: 802-430-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number081850-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: