Provider Demographics
NPI:1538239827
Name:DRYDEN, ANN MARIE LICARI (MSN, APRN)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:LICARI
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 SYMONDS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:VT
Mailing Address - Zip Code:05680-4238
Mailing Address - Country:US
Mailing Address - Phone:802-730-7219
Mailing Address - Fax:
Practice Address - Street 1:756 SYMONDS MILL RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:VT
Practice Address - Zip Code:05680-4238
Practice Address - Country:US
Practice Address - Phone:802-730-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK974363LF0000X, 363LP0808X
VT101.0024283363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily