Healthcare Provider Details

I. General information

NPI: 1447745765
Provider Name (Legal Business Name): ERIN BINGHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 TILLEY DR
SOUTH BURLINGTON VT
05403
US

IV. Provider business mailing address

150 ALLEN RD UNIT 118
SOUTH BURLINGTON VT
05403-3802
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0133177
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134189
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: