MEDICARE: CAROL L BUCK-ROLLAND NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	1010015366	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114970837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L BUCK-ROLLAND NP

Provider Business Mailing Address
First Line	:	307 VILLAGE WOODS
Second Line	:
City	:	WAITSFIELD
State	:	VT
Zip	:	05673-6043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S MAIN ST
Second Line	:
City	:	WATERBURY
State	:	VT
Zip	:	05676-1556
Country	:	US
Telephone Number	:	802-244-5651
Fax Number	:	802-244-5163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/09/2007

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