Provider Demographics
NPI:1861765380
Name:DEWOLF, KATHRYN BRADBURY (MS, CNM)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:BRADBURY
Last Name:DEWOLF
Suffix:
Gender:F
Credentials:MS, CNM
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:BRADBURY
Other - Last Name:DEWOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9300
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCNM0810176B00000X
NH065067-23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079026Medicaid
NH3079026Medicaid