MEDICARE: FIDDLEHEAD LEDGE LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1669146510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDDLEHEAD LEDGE LLC

Provider Business Mailing Address
First Line	:	67 SHAWVILLE RD
Second Line	:
City	:	SHELDON
State	:	VT
Zip	:	05483-8383
Country	:	US
Telephone Number	:	802-933-5702
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 CHURCH ST
Second Line	:
City	:	SWANTON
State	:	VT
Zip	:	05488-1447
Country	:	US
Telephone Number	:	802-868-3175
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINA DUPRAT
Credential	:	APRN FNP-C
Telephone Number	:	802-933-5702

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “FIDDLEHEAD LEDGE LLC ” Practice Location

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