| NPI | 1053754275 |
|---|---|
| Other Name | VERMONT COUNTRY STORE FAMILY WELLNESS CENTER MANCHESTER |
| Entity Type | Organization |
| Authorized Contact | TERRY LAYMAN Corporate Medical Officer 317-727-8698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-10-20 |