Healthcare Provider Details

I. General information

NPI: 1376583427
Provider Name (Legal Business Name): ELLEN W STARR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WASHINGTON ST
BARRE VT
05641-4239
US

IV. Provider business mailing address

PO BOX 218
MONTPELIER VT
05601-0218
US

V. Phone/Fax

Practice location:
  • Phone: 802-476-6696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1010016012
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: