Healthcare Provider Details

I. General information

NPI: 1922332071
Provider Name (Legal Business Name): RACHEL ANN PUTNAM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 TALCOTT RD
WILLISTON VT
05495-2089
US

IV. Provider business mailing address

183 TALCOTT RD
WILLISTON VT
05495-2089
US

V. Phone/Fax

Practice location:
  • Phone: 802-288-8478
  • Fax: 802-879-4800
Mailing address:
  • Phone: 802-288-8478
  • Fax: 802-879-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01534
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: