Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0420014168 | VT |
NPI | 1740308808 |
---|---|
Provider Name | Jeanette Rivera |
First Address | Shelburne, VT 05482-0250 |
Second Address | South Burlington, VT 05403-6491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 29/01/2019 |