Healthcare Provider Details

I. General information

NPI: 1376274167
Provider Name (Legal Business Name): BRIGID JOANNA MEEHAN-BRESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

IV. Provider business mailing address

42 CENTER OF TOWN RD
HARTLAND VT
05048-9595
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-7000
  • Fax:
Mailing address:
  • Phone: 802-595-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135577
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: