Healthcare Provider Details

I. General information

NPI: 1457740318
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 SAINT PAUL ST
BURLINGTON VT
05401-4636
US

IV. Provider business mailing address

128 LAKESIDE AVE STE 301
BURLINGTON VT
05401-5906
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-6326
  • Fax: 802-863-4951
Mailing address:
  • Phone: 802-448-9719
  • Fax: 802-660-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIA JB GREER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 802-448-9719