Healthcare Provider Details

I. General information

NPI: 1013675263
Provider Name (Legal Business Name): ADDISON ANNE HALL AEMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 DOG RIVER DR
NORTHFIELD VT
05663
US

IV. Provider business mailing address

PO BOX 93
MARSHFIELD VT
05658-0093
US

V. Phone/Fax

Practice location:
  • Phone: 760-605-4509
  • Fax:
Mailing address:
  • Phone: 760-605-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number105061
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: