Healthcare Provider Details

I. General information

NPI: 1013400985
Provider Name (Legal Business Name): SHERRI WALDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CRESCENT ST
PENACOOK NH
03303-1468
US

IV. Provider business mailing address

4 CRESCENT ST
PENACOOK NH
03303-1412
US

V. Phone/Fax

Practice location:
  • Phone: 603-753-4302
  • Fax: 603-227-7570
Mailing address:
  • Phone: 603-753-4302
  • Fax: 603-227-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number054890-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: