MEDICARE: JOHANNA POWDEN GOLSTON RN, NP

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	163W00000X	Registered Nurse	647378	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	19126	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	101.0136722	VT

General Provider Information

NPI Number	:	1720146772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA POWDEN GOLSTON RN, NP

Provider Business Mailing Address
First Line	:	359 NORTH RD
Second Line	:
City	:	HINESBURG
State	:	VT
Zip	:	05461-9127
Country	:	US
Telephone Number	:	805-610-4542
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 DORSET ST STE 4
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6240
Country	:	US
Telephone Number	:	802-489-5552
Fax Number	:	802-488-5465

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/15/2024

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