Provider Demographics
NPI:1639843634
Name:NDETAH, SANDRINE (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRINE
Middle Name:
Last Name:NDETAH
Suffix:
Gender:
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:245 HARTFORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-3007
Practice Address - Country:US
Practice Address - Phone:774-295-4355
Practice Address - Fax:774-295-4880
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH113875-23363LF0000X
MARN2391688363LF0000X
390200000X
TX1011418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program