Individual
MS. SHARON L HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
189 PROUTY DR, NEWPORT, VT 05855-9326
(802) 334-4111
(802) 334-3281
Mailing address
189 PROUTY DR, NEWPORT, VT 05855-9326
(802) 334-4111
(802) 334-3281
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0420010181
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00058055
BLUE SHIELD
VT
01
—
07784
MVP
VT
05
—
0VN2542
—
VT
05
—
30201819
—
NH
Enumeration date
11/01/2006
Last updated
07/08/2007
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