Healthcare Provider Details

I. General information

NPI: 1285478222
Provider Name (Legal Business Name): SEANDELL MARIE DURGIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD
BERLIN VT
05602-9516
US

IV. Provider business mailing address

524 CAMP ST
BARRE VT
05641-3254
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-5400
  • Fax:
Mailing address:
  • Phone: 802-272-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137305
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: