Healthcare Provider Details

I. General information

NPI: 1699117630
Provider Name (Legal Business Name): TERRI LYNN REDMOND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-747-1831
  • Fax: 802-747-1826
Mailing address:
  • Phone: 802-747-1831
  • Fax: 802-747-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340998-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134639
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: