Provider Demographics
NPI:1528168762
Name:VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009
Entity type:Organization
Organization Name:VA MEDICAL CENTER 215 NORTH MAIN STREET WRJ VT 05009
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1802-295-9363
Mailing Address - Street 1:7 ORCHARD HILL LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-4702
Mailing Address - Country:US
Mailing Address - Phone:603-643-8441
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0342382305261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center