Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 101.0109654 | VT |
NPI | 1003205915 |
---|---|
Provider Name | Eliza W Anti |
First Address | Barre, VT 05641-0547 |
Second Address | Barre, VT 05641-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 21/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1024467 | (05) | VT |