Healthcare Provider Details

I. General information

NPI: 1265556021
Provider Name (Legal Business Name): VICKI MARIE KIRBY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RTE 73
ORWELL VT
05760-9625
US

IV. Provider business mailing address

636 RTE 73
ORWELL VT
05760-9625
US

V. Phone/Fax

Practice location:
  • Phone: 802-236-4136
  • Fax: 802-948-2172
Mailing address:
  • Phone: 802-236-4136
  • Fax: 802-948-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0260020659
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0260020659
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number260020659
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: