=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386270320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE E FRIEDL APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2020
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 HOOKSETT RD UNIT 1
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-255-4775
-----------------------------------------------------
Fax | 603-255-4776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 US HIGHWAY 1 BYP UNIT 102
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-410-6700
-----------------------------------------------------
Fax | 603-319-8308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0102X
-----------------------------------------------------
Taxonomy Name | Maternal Newborn Registered Nurse
-----------------------------------------------------
License Number | 073284-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 211622
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------