Healthcare Provider Details

I. General information

NPI: 1144889692
Provider Name (Legal Business Name): SETU GEDDES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SETU GANDHI

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 PEMBROKE ST
PEMBROKE NH
03275-1311
US

IV. Provider business mailing address

121 PEMBROKE ST
PEMBROKE NH
03275-1311
US

V. Phone/Fax

Practice location:
  • Phone: 603-485-8441
  • Fax: 603-227-7563
Mailing address:
  • Phone: 603-485-8441
  • Fax: 603-227-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number060201-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: