Provider Demographics
NPI:1194856922
Name:TAUTFEST, JAMES (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TAUTFEST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-2613
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:802-728-2613
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-00179681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010580Medicaid
VT18466OtherBLUE CROSS PROVIDER #
VT1010580Medicaid
VT18466OtherBLUE CROSS PROVIDER #