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General NPI Number Information
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NPI Number | 1053307918
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Entity Type | Individual
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Provider Name | ALICE CECILE PEZZULICH FNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 9 CHURCH ST.
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City | ARLINGTON
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State | VT
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Zip | 05250
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Country | US
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Telephone | 802-375-6566
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Fax | 802-375-6828
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Provider Business Mailing Address
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Address Line | 9 CHURCH STREET PO BOX 690
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City | ARLINGTON
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State | VT
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Zip | 05250-0690
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Country | US
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Telephone | 802-375-6566
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Fax | 802-375-6828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0027640
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License Number State | VT
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