Provider Demographics
NPI:1265199731
Name:CORREIA, JOSHUA DAVID (BSN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:CORREIA
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 KILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4227
Mailing Address - Country:US
Mailing Address - Phone:505-321-0688
Mailing Address - Fax:
Practice Address - Street 1:87 KILLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4227
Practice Address - Country:US
Practice Address - Phone:505-321-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0136889163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency