Provider Demographics
NPI:1356126601
Name:WILLOW BROOK FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:WILLOW BROOK FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-469-2055
Mailing Address - Street 1:412 WILLOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-5209
Mailing Address - Country:US
Mailing Address - Phone:603-469-2055
Mailing Address - Fax:603-469-2044
Practice Address - Street 1:7 CAMPUS CENTER DR
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:NH
Practice Address - Zip Code:03770-5402
Practice Address - Country:US
Practice Address - Phone:603-469-2055
Practice Address - Fax:603-469-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty