Healthcare Provider Details

I. General information

NPI: 1669979068
Provider Name (Legal Business Name): CHERYL UNDERWOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PARK AVE
WILLISTON VT
05495-9701
US

IV. Provider business mailing address

363 CARPENTER HILL RD
SAINT ALBANS VT
05478-6096
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-1008
  • Fax: 802-872-2679
Mailing address:
  • Phone: 802-345-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number026.0027479
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134237
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: