Healthcare Provider Details

I. General information

NPI: 1407348675
Provider Name (Legal Business Name): LINDSEY VICTORIA COWARD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST BLDG 4
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

61 PINE ST BLDG 4
BRISTOL VT
05443-1043
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-3911
  • Fax: 802-453-6105
Mailing address:
  • Phone: 802-453-3911
  • Fax: 802-453-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21807
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0134517
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: