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General NPI Number Information
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NPI Number | 1124538814
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Entity Type | Individual
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Provider Name | MATTHEW DOVE FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 1 ANNA MARSH LANE, BRATTLEBORO, VT 05301
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City | WINCHESTER
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State | VT
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Zip | 22601-5178
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Country | US
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Telephone | 304-261-5991
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ANNA MARSH LANE, BRATTLEBORO, VT 05301
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City | WINCHESTER
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State | VT
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Zip | 05301-4336
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Country | US
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Telephone | 304-261-5991
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0134163
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0134163
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License Number State | VT
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