Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 101.0134888 | VT |
NPI | 1013526466 |
---|---|
Provider Name | Deborah Anne Tenenbaum |
First Address | Barre, VT 05641-5360 |
Second Address | Barre, VT 05641-5360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2020 |
Last Update Date | 02/02/2022 |