Healthcare Provider Details

I. General information

NPI: 1740156272
Provider Name (Legal Business Name): JENNIFER MARGUERITE GOULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 VT 12 APT D
HARTLAND VT
05048-9460
US

IV. Provider business mailing address

16 VT 12 APT D
HARTLAND VT
05048-9460
US

V. Phone/Fax

Practice location:
  • Phone: 978-502-7966
  • Fax: 978-502-7966
Mailing address:
  • Phone: 978-502-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0153053
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: