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General NPI Number Information
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NPI Number | 1417064015
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Entity Type | Individual
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Provider Name | BETHANY JANE MUNN RPSGT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3472 AIRPORT ROAD
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City | MONTPELIER
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State | VT
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Zip | 05602
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Country | US
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Telephone | 802-659-4481
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Fax | 866-745-4463
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Provider Business Mailing Address
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Address Line | PO BOX 2281
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05407-2281
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Country | US
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Telephone | 802-659-4481
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Fax | 866-745-4463
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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