Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 135263 | MA |
NPI | 1043328693 |
---|---|
Provider Name | Ms. P Spencer Burdge |
First Address | White River Junction, VT 05009-0001 |
Second Address | White River Junction, VT 05009-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 13/07/2007 |