Provider Demographics
NPI:1952759904
Name:FIELDS, BETTY (APRN)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 COUNTY ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089
Mailing Address - Country:US
Mailing Address - Phone:802-457-3030
Mailing Address - Fax:802-457-2157
Practice Address - Street 1:32 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091
Practice Address - Country:US
Practice Address - Phone:802-457-3030
Practice Address - Fax:802-457-2157
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH034630-23363L00000X
VT101.0119556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1029111Medicaid
NH3106641Medicaid