Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 175F00000X | VT |
NPI | 1043760721 |
---|---|
Provider Name | Nicole Kearney |
First Address | South Burlington, VT 05403-4484 |
Second Address | South Burlington, VT 05403-4484 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099.0122006 | LICENSE (01) | VT |