Organization
NORTHWESTERN MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESE M TUCKER (ENROLLMENT SPECIALIST)
(802) 524-8954
Entity
Organization
Contact information
Practice address
260 CREST RD STE 204, SAINT ALBANS, VT 05478-9502
(802) 752-1992
(802) 752-1993
Mailing address
133 FAIRFIELD ST, SAINT ALBANS, VT 05478-1726
(802) 524-5911
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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