Individual
TIMOTHY KANCZUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
1 ANNA MARSH LANE, BRATTLEBORO, VT 05301
(802) 258-3700
Mailing address
1 ANNA MARSH LANE, BRATTLEBORO, VT 05301
(802) 257-7785
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
026.0128223
VT
163W00000X
Registered Nurse
4704311906
MI
363L00000X
Nurse Practitioner
Primary
101.0134267
VT
Other
Enumeration date
09/02/2016
Last updated
06/11/2019
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