Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 101-0025805 | VT |
NPI | 1033228960 |
---|---|
Provider Name | Mrs. Stacey K Whitten |
First Address | Arlington, VT 05250 |
Second Address | Bennington, VT 05201-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |