Healthcare Provider Details

I. General information

NPI: 1114402567
Provider Name (Legal Business Name): DIANE FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 GLEN RD
BURLINGTON VT
05401-4131
US

IV. Provider business mailing address

76 GLEN RD
BURLINGTON VT
05401-4131
US

V. Phone/Fax

Practice location:
  • Phone: 802-861-2584
  • Fax: 802-864-1619
Mailing address:
  • Phone: 802-861-2584
  • Fax: 802-864-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: