1770794349 NPI number — BARBARA GROTHE-PENNEY APRN, ANP

Table of content: BARBARA GROTHE-PENNEY APRN, ANP (NPI 1770794349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770794349 NPI number — BARBARA GROTHE-PENNEY APRN, ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROTHE-PENNEY
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770794349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05641-0547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-371-4316
Provider Business Mailing Address Fax Number:
802-371-4579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 FISHER RD
Provider Second Line Business Practice Location Address:
CENTRAL VERMONT MEDICAL CENTER
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-9516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-371-4316
Provider Business Practice Location Address Fax Number:
802-371-4579
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  101-0010883 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1009633 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP412501 . This is a "MEDICARE PTAN LINKED TO CVMC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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