Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1010025996 | VT |
NPI | 1003013608 |
---|---|
Provider Name | Emily Byrne |
First Address | Barre, VT 05641-0547 |
Second Address | Montpelier, VT 05602-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 10/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013922 | (05) | VT |
P83308 | (02) |