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General NPI Number Information
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NPI Number | 1346769668
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Entity Type | Organization
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Legal Business Name | MINDS OVER MATTER, PC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 73 CENTER ST STE 2
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-772-7136
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Fax | 866-271-4702
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Provider Business Mailing Address
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Address Line | 73 CENTER ST STE 2
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-772-7136
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Fax | 866-271-4702
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | BRANDI AMBER RAND
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Credential |
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Telephone | 802-772-7136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101-0082934
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License Number State | VT
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