| NPI | 1194358168 |
|---|---|
| Other Name | NEW BALANCE NORRIDGEWOCK |
| Entity Type | Organization |
| Authorized Contact | JERRY FORD CEO 802-857-0400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-01-06 |