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General NPI Number Information
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NPI Number | 1639572647
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Entity Type | Individual
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Provider Name | SANDRA KEDDY CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2014
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 1 PILLSBURY ST
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City | CONCORD
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State | NH
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Zip | 03301-3556
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Country | US
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Telephone | 603-224-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GREENSBORO RD
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City | HANOVER
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State | NH
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Zip | 03755-3100
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Country | US
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Telephone | 864-505-2454
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 039078-21
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 039078-23
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License Number State | NH
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