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General NPI Number Information
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NPI Number | 1528168762
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | VA MEDICAL CTR
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05009-0001
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Country | US
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Telephone | 802-295-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 7 ORCHARD HILL LN
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City | HANOVER
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State | NH
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Zip | 03755-4702
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Country | US
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Telephone | 603-643-8441
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Fax |
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Authorized Official
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Title or Position | ADULT NURSE PRACTITIONER
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Name | MARION BURCHARD
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Credential |
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Telephone | 18022959363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0342382305
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License Number State | NH
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