Provider Demographics
NPI:1275368110
Name:SAMPSON, LAUREN ANN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CREAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05701-6860
Mailing Address - Country:US
Mailing Address - Phone:802-779-7749
Mailing Address - Fax:
Practice Address - Street 1:612 CREAM HILL RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:VT
Practice Address - Zip Code:05701-6860
Practice Address - Country:US
Practice Address - Phone:802-779-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT431167032255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer