Active NPI
Victor Boardman
- Nurse's Aide
- South Burlington, VT
National Provider Identifier
1053732792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 0750016788
- Practice address
- 404 Sugar Tree LN
South Burlington, VT 05403-6780 - Phone
- (802) 660-4046
- NPI assigned
- Dec 24, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 0750016788 | VT | Primary |
Addresses
Primary practice location
404 Sugar Tree LN
South Burlington, VT 05403-6780
Mailing address
120 Hegeman Ave
Colchester, VT 05446-3156
Phone (802) 660-4046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0750016788 | VT | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387843200000",
"number": "1053732792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 HEGEMAN AVE",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054463156",
"telephone_number": "802-660-4046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 SUGAR TREE LN",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054036780",
"telephone_number": "802-660-4046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOARDMAN",
"first_name": "VICTOR",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-24",
"last_updated": "2013-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "VT",
"license": "0750016788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.