Individual
MS. ANN E GOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1 S PROSPECT ST, BURLINGTON, VT 05401-3456
(802) 847-4576
Mailing address
67 BORESTONE LN, BURLINGTON, VT 05401-1842
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
101-0012931
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0NP1010
—
VT
Enumeration date
08/31/2006
Last updated
07/21/2022
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