Individual
MARIA THAIVEETTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
163 VETERANS DR, WHITE RIVER JUNCTION, VT 05009-0001
(802) 295-9363
Mailing address
1118 RANDOLPH ST APT 1W, OAK PARK, IL 60302-5503
(503) 750-9007
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F06190348
IL
Other
Enumeration date
07/16/2019
Last updated
07/16/2019
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