Healthcare Provider Details

I. General information

NPI: 1982357935
Provider Name (Legal Business Name): HEIDI ANN CARLEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SOUTH MAIN STREET
WILMINGTON VT
05363
US

IV. Provider business mailing address

6 SOUTH MAIN STREET
WILMINGTON VT
05363
US

V. Phone/Fax

Practice location:
  • Phone: 802-464-8333
  • Fax: 802-464-8313
Mailing address:
  • Phone: 802-464-8333
  • Fax: 802-464-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number026.0130077
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number026.0130077
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number026.0130077
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number026.0130077
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: