Healthcare Provider Details

I. General information

NPI: 1033977368
Provider Name (Legal Business Name): LEE-ANN GREGG STUDENT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

IV. Provider business mailing address

502 GOVE HILL RD
THETFORD CENTER VT
05075-8994
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-7000
  • Fax:
Mailing address:
  • Phone: 603-998-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0139184
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: