Healthcare Provider Details

I. General information

NPI: 1952977134
Provider Name (Legal Business Name): HANNAH MARIE PREVOST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HOSPITAL DR
ST JOHNSBURY VT
05819-9239
US

IV. Provider business mailing address

PO BOX 183
WEST DANVILLE VT
05873-0183
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-8757
  • Fax:
Mailing address:
  • Phone: 802-535-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134802
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: