Healthcare Provider Details

I. General information

NPI: 1245668094
Provider Name (Legal Business Name): ISABELLE WADDELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CRESCENT ST
PENACOOK NH
03303-1412
US

IV. Provider business mailing address

4 CRESCENT ST
PENACOOK NH
03303-1412
US

V. Phone/Fax

Practice location:
  • Phone: 603-753-4302
  • Fax: 603-753-6213
Mailing address:
  • Phone: 603-753-4302
  • Fax: 603-753-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9253324
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number071271-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: