Provider Demographics
NPI:1003872102
Name:KRUPP, BRENDA S (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:KRUPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:CIAMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:246 PLEASANT ST STE G2
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-3388
Mailing Address - Fax:603-227-7536
Practice Address - Street 1:246 PLEASANT ST STE G2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-3388
Practice Address - Fax:603-227-7536
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant