Provider Demographics
NPI:1649630427
Name:THE UNIVERSITY OF VERMONT MEDICAL CENTER
Entity type:Organization
Organization Name:THE UNIVERSITY OF VERMONT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-324-9194
Mailing Address - Street 1:236 ZEPHYR RD
Mailing Address - Street 2:206
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7931
Mailing Address - Country:US
Mailing Address - Phone:802-324-9194
Mailing Address - Fax:
Practice Address - Street 1:236 ZEPHYR RD
Practice Address - Street 2:206
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7931
Practice Address - Country:US
Practice Address - Phone:802-324-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0028569261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service