Healthcare Provider Details

I. General information

NPI: 1548623416
Provider Name (Legal Business Name): VERMONT NATURAL FAMILY MEDICINE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 KILBURN ST
BURLINGTON VT
05401-4750
US

IV. Provider business mailing address

13 KILBURN ST
BURLINGTON VT
05401-4750
US

V. Phone/Fax

Practice location:
  • Phone: 802-238-8603
  • Fax:
Mailing address:
  • Phone: 802-238-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0072105
License Number StateVT

VIII. Authorized Official

Name: DR. JOSHUA D GREEN
Title or Position: OWNER AND CLINICAL DIRECTOR
Credential: ND
Phone: 802-598-2244