Healthcare Provider Details

I. General information

NPI: 1184250961
Provider Name (Legal Business Name): VERMONT DONOR MILK CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 LINCOLN ST
ESSEX JCT VT
05452-3152
US

IV. Provider business mailing address

37 LINCOLN ST
ESSEX JCT VT
05452-3152
US

V. Phone/Fax

Practice location:
  • Phone: 802-276-0030
  • Fax:
Mailing address:
  • Phone: 802-276-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL FOXX
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, IBCLC
Phone: 802-276-0030