Provider Demographics
NPI:1811592579
Name:WAKEFIELD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:WAKEFIELD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-871-8227
Mailing Address - Street 1:131 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-4329
Mailing Address - Country:US
Mailing Address - Phone:603-871-8227
Mailing Address - Fax:603-871-8285
Practice Address - Street 1:131 MEADOW ST
Practice Address - Street 2:
Practice Address - City:SANBORNVILLE
Practice Address - State:NH
Practice Address - Zip Code:03872-4329
Practice Address - Country:US
Practice Address - Phone:603-871-8227
Practice Address - Fax:603-871-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty