Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0420010741 | VT |
NPI | 1275661092 |
---|---|
Provider Name | Heidi Zvolensky |
First Address | Saint Albans, VT 05478-9701 |
Second Address | Saint Albans, VT 05478-9701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010530 | (05) | VT |
68124 | BLUE CROSS BLUE SHIELD (01) | VT |