Facts
- Status
- A
- Credential
- RDH,LNA
- Type
- Individual
- Enumeration date
- 2021-08-16
- Last updated
- 2021-08-16
Specialties
Licenses
- License VT
- 015.0000979
Location
- Practice location
- 875 BLUE STAR DR
- City
- CASTLETON VT
- Postal code
- 057359177
- Phone
- 518-361-8677
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.