Healthcare Provider Details

I. General information

NPI: 1801061973
Provider Name (Legal Business Name): ANNE T STANDISH N.P.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4178 HIGHBRIDGE RD
FAIRFAX VT
05454-5446
US

IV. Provider business mailing address

4178 HIGHBRIDGE RD
FAIRFAX VT
05454-5446
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-9595
  • Fax: 802-524-2867
Mailing address:
  • Phone: 802-524-9595
  • Fax: 802-524-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0017609
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: