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General NPI Number Information
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NPI Number | 1528088507
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Entity Type | Individual
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Provider Name | PHAEDRA MCDONOUGH ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 580 COURT ST
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City | KEENE
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State | NH
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Zip | 03431-1718
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Country | US
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Telephone | 603-354-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 266 MAIN ST APT 2
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City | KEENE
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State | NH
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Zip | 03431-4144
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Country | US
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Telephone | 603-357-7913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0320062303
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License Number State | NH
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