Healthcare Provider Details

I. General information

NPI: 1992454920
Provider Name (Legal Business Name): TATYANA MAKHLINA-ECKSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATYANA MAKHLINA

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

16 MADISON DR
WILLISTON VT
05495-4447
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2452
  • Fax:
Mailing address:
  • Phone: 857-231-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101-0135467
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0120173
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: