Organization
WILD PRAIRIE PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNIPER VALE MD (OWNER)
(603) 727-9175
Entity
Organization
Contact information
Practice address
240 MECHANIC ST STE 201, LEBANON, NH 03766-2617
(971) 235-9657
Mailing address
240 MECHANIC ST STE 201, LEBANON, NH 03766-2617
(603) 727-9175
(603) 988-0711
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/28/2025
Last updated
10/18/2025
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