Healthcare Provider Details

I. General information

NPI: 1932693355
Provider Name (Legal Business Name): ELSA M INGPEN DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MCNEIL RD
WATERBURY CENTER VT
05677-7161
US

IV. Provider business mailing address

1653 KENT HILL RD
EAST CALAIS VT
05650-8043
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-4239
  • Fax:
Mailing address:
  • Phone: 802-595-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134168
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: