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General NPI Number Information
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NPI Number | 1801208418
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Entity Type | Individual
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Provider Name | KIM NICOLE DACEK
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Gender | Female
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 875 ROOSEVELT HWY STE 132
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City | COLCHESTER
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State | VT
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Zip | 05446-4460
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Country | US
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Telephone | 802-864-7483
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Fax | 802-660-4337
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Provider Business Mailing Address
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Address Line | 875 ROOSEVELT HWY STE 132
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City | COLCHESTER
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State | VT
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Zip | 05446-4460
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Country | US
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Telephone | 802-864-7483
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Fax | 802-660-4337
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0107576
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2284328
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License Number State | MA
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