Healthcare Provider Details

I. General information

NPI: 1760457964
Provider Name (Legal Business Name): GENEVA L. PEDERSEN APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 LAPORTE RD
MORRISVILLE VT
05661
US

IV. Provider business mailing address

1126 LAPORTE RD PO BOX 608
MORRISVILLE VT
05661
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-2448
  • Fax:
Mailing address:
  • Phone: 802-888-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0074886
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number178714
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: