Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1010020508 | VT |
NPI | 1023180924 |
---|---|
Provider Name | Patricia Manion |
First Address | Burlington, VT 05401-5429 |
Second Address | Burlington, VT 05401-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 21/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1009818 | (05) | VT |
2160482 | CIGNA (01) | VT |
39461 | BLUE CROSS (01) | VT |
P99092 | (02) | VT |