Provider Demographics
NPI:1871983841
Name:SLOSSBERG, BRENDA (ARNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SLOSSBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-542-7888
Mailing Address - Fax:603-542-7898
Practice Address - Street 1:243 ELM STREET
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-542-7888
Practice Address - Fax:603-542-7898
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH070952-21363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100112Medicaid
VT1024443Medicaid