Healthcare Provider Details

I. General information

NPI: 1689060238
Provider Name (Legal Business Name): REBECCA A. MARIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L. ABEL RN

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE. UVM MEDICAL CENTER - NEUROLOGY
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE. UVM MEDICAL CENTER - NEUROLOGY
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4589
  • Fax: 802-847-2461
Mailing address:
  • Phone: 802-847-4589
  • Fax: 802-847-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0111754
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0035329
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: