MEDICARE: LEAH M FLORE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	101-0021850	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013972116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH M FLORE FNP

Provider Business Mailing Address
First Line	:	600 BLAIR PARK RD
Second Line	:	SUITE 190
City	:	WILLISTON
State	:	VT
Zip	:	05495-7586
Country	:	US
Telephone Number	:	802-872-4343
Fax Number	:	802-872-0282

Provider Business Practice Location Address
First Line	:	51 TIMBER LN
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5201
Country	:	US
Telephone Number	:	802-864-0521
Fax Number	:	802-864-6475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	06/06/2013

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