Healthcare Provider Details

I. General information

NPI: 1114992518
Provider Name (Legal Business Name): MARILYN T MCDONALD A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HAYWOOD AVE MOUNTAIN VIEW CENTER
RUTLAND VT
05701-4832
US

IV. Provider business mailing address

9 TOWN LINE RD
MENDON VT
05701-9635
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-0007
  • Fax: 802-775-6895
Mailing address:
  • Phone: 802-775-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number101-0019819
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: