Basic Information
| Provider Information | |||||||||
| NPI: | 1366528143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANSFIELD | ||||||||
| FirstName: | LAURI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANSFIELD-MARCOUX | ||||||||
| OtherFirstName: | LAURI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 32 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050911122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024573030 | ||||||||
| FaxNumber: | 8024572157 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050911122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024573030 | ||||||||
| FaxNumber: | 8024572157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 042-0010313 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.