Provider Demographics
NPI:1679087886
Name:BEHRENDT, JOSEFA
Entity type:Individual
Prefix:
First Name:JOSEFA
Middle Name:
Last Name:BEHRENDT
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 1:2235 VT ROUTE 103
Mailing Address - Street 2:
Mailing Address - City:CUTTINGSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05738-9612
Mailing Address - Country:US
Mailing Address - Phone:802-773-3563
Mailing Address - Fax:
Practice Address - Street 1:232 WEST ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-2850
Practice Address - Country:US
Practice Address - Phone:802-772-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0008555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse