Healthcare Provider Details

I. General information

NPI: 1831154616
Provider Name (Legal Business Name): ALLISON PAGE NIEMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 VT ROUTE 7A
SHAFTSBURY VT
05262-9548
US

IV. Provider business mailing address

677 VT ROUTE 7A P O BOX 379
SHAFTSBURY VT
05262-9548
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8531
  • Fax: 802-442-1503
Mailing address:
  • Phone: 802-442-9531
  • Fax: 802-442-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0010745
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: