Healthcare Provider Details

I. General information

NPI: 1093404329
Provider Name (Legal Business Name): BEWELL PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH ST STE 4
BENNINGTON VT
05201-2894
US

IV. Provider business mailing address

210 SOUTH ST STE 4
BENNINGTON VT
05201-2894
US

V. Phone/Fax

Practice location:
  • Phone: 802-753-7785
  • Fax: 802-753-7082
Mailing address:
  • Phone: 802-753-7785
  • Fax: 802-753-7082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER M STEINHOFF
Title or Position: OWNER
Credential: APRN, FNP-BC
Phone: 802-753-7785