Basic Information
| Provider Information | |||||||||
| NPI: | 1457709230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 168 KINSLEY ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038821501 | ||||||||
| FaxNumber: | 6038829747 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 KINSLEY ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038821501 | ||||||||
| FaxNumber: | 6038829747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 062841-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 3115693 | 05 | NH | MEDICAID |