Organization
FAODAIL PAIN MANAGEMENT, PLLC
Active
Other names
Full Life Pain and Depression Center
Organization subpart
No
Provider details
NPI number
Authorized official
MELYNDA WALLACE CRNA, DNP, MSN (OWNER)
(603) 309-3902
Entity
Organization
Contact information
Practice address
151 ROUTE 10 N UNIT 2, GRANTHAM, NH 03753-3621
(603) 309-3902
(603) 843-8176
Mailing address
252 MECHANIC ST, LEBANON, NH 03766-2613
(603) 448-1941
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
07/25/2023
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