Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 042-0009231 | VT |
N | 207QA0401X | Family Doctor - Addiction Medicine | 265685 | MA |
NPI | 1598022204 |
---|---|
Provider Name | Wendy L Leffel |
First Address | Pownal, VT 05261-9448 |
Second Address | Bennington, VT 05201-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 30/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OVN1652 | (05) | VT |