Provider Demographics
NPI:1659542066
Name:BANNENBERG, CILIA EM (NHCM, CPM)
Entity Type:Individual
Prefix:MS
First Name:CILIA
Middle Name:EM
Last Name:BANNENBERG
Suffix:
Gender:F
Credentials:NHCM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-0381
Mailing Address - Country:US
Mailing Address - Phone:603-332-7766
Mailing Address - Fax:
Practice Address - Street 1:101 GREENHILL ROAD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-0381
Practice Address - Country:US
Practice Address - Phone:603-332-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30462517Medicaid