Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | NH5950 | NH |
N | 207Q00000X | Family Doctor | VT0420007200 | VT |
N | 207QA0401X | Family Doctor - Addiction Medicine | NH5950 | NH |
N | 207QA0401X | Family Doctor - Addiction Medicine | VT0420007200 | VT |
NPI | 1740475490 |
---|---|
Provider Name | Dr. Carol Susan Ribner |
First Address | Jefferson, NH 03583-6217 |
Second Address | Jefferson, NH 03583-6217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80000055 | (05) | NH |