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General NPI Number Information
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NPI Number | 1891196804
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Entity Type | Individual
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Provider Name | THERESA HAYWOOD N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 275 ROUTE 30 N
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City | BOMOSEEN
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State | VT
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Zip | 05732-9647
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Country | US
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Telephone | 802-468-5641
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Fax | 802-468-2923
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Provider Business Mailing Address
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Address Line | 71 ALLEN ST STE 403
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City | RUTLAND
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State | VT
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Zip | 05701-4570
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Country | US
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Telephone | 802-772-4414
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Fax | 802-772-7973
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0103560
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0103560
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License Number State | VT
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