Healthcare Provider Details

I. General information

NPI: 1962951509
Provider Name (Legal Business Name): EMILY GROSE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BELMONT AVENUE, GANNETT BUILDING 1ST FLOOR
BRATTLEBORO VT
05301-0530
US

IV. Provider business mailing address

17 BELMONT AVENUE
BRATTLEBORO VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 802-251-8787
  • Fax: 802-251-9972
Mailing address:
  • Phone: 802-257-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM0356
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1010134331
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: