| NPI | 1487476867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESE M TUCKER Enrollment Specialist 802-524-8954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |