Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1010016208 | VT |
NPI | 1003075508 |
---|---|
Provider Name | Ms. Madeline B Mann |
First Address | Williston, VT 05495-9308 |
Second Address | Milton, VT 05468-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015415 | (05) | VT |