Provider Demographics
NPI:1427002740
Name:WYNINEGAR, RACHEL LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:WYNINEGAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:25 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6708
Mailing Address - Country:US
Mailing Address - Phone:603-695-2998
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTH RIVER ROAD
Practice Address - Street 2:ORTHOPAEDICS/PODIATRY
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-695-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065451-21163W00000X
MA258927363LA2100X
NH065451-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse