Healthcare Provider Details

I. General information

NPI: 1083787618
Provider Name (Legal Business Name): MARGARET ANNE MACDONALD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

65 LEE RIVER RD
JERICHO VT
05465-3060
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2653
  • Fax: 802-847-5176
Mailing address:
  • Phone: 802-899-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101-0020011
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: