| NPI | 1356598742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELLA SOPHIE DOUGLAS Owner 802-876-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 1010020560) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-08-27 |