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General NPI Number Information
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NPI Number | 1396276655
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Entity Type | Organization
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Legal Business Name | PEMBROKE WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 48 GLASS ST
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City | PEMBROKE
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State | NH
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Zip | 03275-1506
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Country | US
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Telephone | 603-485-7788
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Fax | 603-485-7799
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Provider Business Mailing Address
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Address Line | 48 GLASS ST
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City | PEMBROKE
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State | NH
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Zip | 03275-1506
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Country | US
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Telephone | 603-485-7788
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Fax | 603-485-7799
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Authorized Official
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Title or Position | RN OFFICE MANAGER
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Name | DEBBORAH KAITZ KAITZ
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Credential |
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Telephone | 603-485-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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