Healthcare Provider Details

I. General information

NPI: 1609888684
Provider Name (Legal Business Name): DURRELLE T WHITMORE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 VILLAGE ROAD
EAST CORINTH VT
05040
US

IV. Provider business mailing address

4 SKUNK HOLLOW RD
EAST HARDWICK VT
05836-9739
US

V. Phone/Fax

Practice location:
  • Phone: 802-439-5321
  • Fax:
Mailing address:
  • Phone: 802-533-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60303523
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1010101436
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1813
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: