Healthcare Provider Details

I. General information

NPI: 1306911615
Provider Name (Legal Business Name): MEGHEN ANNE CLANCY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH CARE AND REHABILITATION CENTER 107 PARK ST
SPRINGFIELD VT
05156
US

IV. Provider business mailing address

ONE HOSPITAL COURT SUITE 410
BELLOWS FALLS VT
05101
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-5781
  • Fax: 802-885-4857
Mailing address:
  • Phone: 802-463-3947
  • Fax: 802-463-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1010014569
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: