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General NPI Number Information
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NPI Number | 1326594359
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Entity Type | Organization
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Legal Business Name | VERMONT HOLISTIC HEALTH PLLC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 5053 MAIN ST
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City | MANCHESTER CENTER
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State | VT
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Zip | 05255-9771
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Country | US
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Telephone | 802-293-2929
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Fax | 802-419-8311
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Provider Business Mailing Address
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Address Line | 704 STAPLES RD
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City | DANBY
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State | VT
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Zip | 05739-9341
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Country | US
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Telephone | 802-293-2929
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Fax | 802-419-8311
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM L GOODWIN
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Credential | FNP
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Telephone | 802-293-2929
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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 | 101.0107976
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License Number State | VT
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