Healthcare Provider Details

I. General information

NPI: 1538455266
Provider Name (Legal Business Name): MICHELE MARIE REDMOND RN, BSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 30 N
BOMOSEEN VT
05732-9647
US

IV. Provider business mailing address

275 ROUTE 30 N
BOMOSEEN VT
05732-9647
US

V. Phone/Fax

Practice location:
  • Phone: 802-468-5641
  • Fax: 802-468-2923
Mailing address:
  • Phone: 802-468-5641
  • Fax: 802-468-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0260019322
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: