Healthcare Provider Details

I. General information

NPI: 1477514362
Provider Name (Legal Business Name): SUSAN F. DUMAS ADULT NURSE PRACTITI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN FRANCES BABCOCK ANP

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ALLEN ST
RUTLAND VT
05701-4562
US

IV. Provider business mailing address

92 ALLEN ST
RUTLAND VT
05701-4562
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-7502
  • Fax: 802-773-7022
Mailing address:
  • Phone: 802-773-7502
  • Fax: 802-773-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1010015655
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: