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General NPI Number Information
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NPI Number | 1851712657
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN FAMILY MEDICINE
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 199 STRATTON RD
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City | RUTLAND
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State | VT
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Zip | 05701-4890
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Country | US
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Telephone | 802-775-7798
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Fax | 802-775-7762
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Provider Business Mailing Address
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Address Line | 199 STRATTON RD
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City | RUTLAND
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State | VT
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Zip | 05701-4890
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Country | US
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Telephone | 802-775-7798
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Fax | 802-775-7762
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Authorized Official
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Title or Position | APRN
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Name | CRISTIN ALEXANDRIA CRAFT
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Credential | APRN
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Telephone | 802-775-7798
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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 | 101.0100410
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License Number State | VT
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