Provider Demographics
NPI:1881303162
Name:GREENOUGH, VICTORIA MAE (DNP, APRN, RN)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:MAE
Last Name:GREENOUGH
Suffix:
Gender:F
Credentials:DNP, APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:792 COLLEGE PARKWAY FANNY ALLEN CAMPUS, MEDICAL OFFICE
Mailing Address - Street 2:LEVEL 2, SUITE 205
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:792 COLLEGE PARKWAY FANNY ALLEN CAMPUS, MEDICAL OFFICE
Practice Address - Street 2:LEVEL 2, SUITE 205
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-847-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT026.0140121163W00000X
VT101-0135961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse