Healthcare Provider Details

I. General information

NPI: 1073690707
Provider Name (Legal Business Name): ANNE G BAYLOCK ADV PRACTICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMONS ST
RUTLAND VT
05701-4652
US

IV. Provider business mailing address

89 TOWN HILL RD PO BOX 573
PITTSFORD VT
05763-0573
US

V. Phone/Fax

Practice location:
  • Phone: 802-747-1857
  • Fax: 802-747-0129
Mailing address:
  • Phone: 802-483-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0420010759
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: