MEDICARE: BRENDA M SANBORN CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	020455-21	NH

General Provider Information

NPI Number	:	1487771895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA M SANBORN CNM

Provider Business Mailing Address
First Line	:	150 TARRYTOWN ROAD
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-2713
Country	:	US
Telephone Number	:	603-622-3162
Fax Number	:	603-622-8677

Provider Business Practice Location Address
First Line	:	150 TARRYTOWN RD
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-2713
Country	:	US
Telephone Number	:	603-622-3162
Fax Number	:	603-622-8677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	05/22/2013

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