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General NPI Number Information
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NPI Number | 1609587492
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Entity Type | Individual
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Provider Name | TAMMY S DEVEREUX APRN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 79 CENTER ST STE 1-1
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City | RUTLAND
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State | VT
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Zip | 05701-4061
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Country | US
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Telephone | 802-772-7107
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Fax | 802-772-9003
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Provider Business Mailing Address
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Address Line | 30 GRAPE ST
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City | FAIR HAVEN
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State | VT
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Zip | 05743-1049
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Country | US
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Telephone | 802-772-7107
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Fax | 802-772-9003
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 101.0135875
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License Number State | VT
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