Individual
CANDIS JOAN COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
364 DORSET ST, STE 2, SOUTH BURLINGTON, VT 05403-6270
(802) 859-9500
Mailing address
123 HANLEY LANE, JERICHO, VT 05465
(802) 899-9960
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
550030284
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08V151
MVP
—
05
—
2000061
—
VT
Enumeration date
08/28/2006
Last updated
02/07/2011
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