=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942634985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBEKAH TURNER REDDEL APRN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2013
-----------------------------------------------------
Last Update Date | 09/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 ROUTE 101 UNIT 26
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-930-6662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 ROBIN HOOD DR
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-4021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-930-6662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | REBEKAH TURNER REDDEL
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 603-930-6662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 023022-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------