Healthcare Provider Details

I. General information

NPI: 1922962521
Provider Name (Legal Business Name): LINDSEY BOULTER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 RIVER ST
SPRINGFIELD VT
05156-2226
US

IV. Provider business mailing address

390 RIVER ST
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-886-4500
  • Fax: 802-886-4500
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: