Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 032-0000533 | VT |
NPI | 1346356060 |
---|---|
Provider Name | Carol Joy Gardner |
First Address | Colchester, VT 05446-4475 |
Second Address | Colchester, VT 05446-4475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 23/01/2015 |