Basic Information
| Provider Information | |||||||||
| NPI: | 1801061973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANDISH | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4178 HIGHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054545446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025249595 | ||||||||
| FaxNumber: | 8025242867 | ||||||||
| Practice Location | |||||||||
| Address1: | 4178 HIGHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054545446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025249595 | ||||||||
| FaxNumber: | 8025242867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 101-0017609 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1014907 | 05 | VT | MEDICAID |