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General NPI Number Information
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NPI Number | 1578697884
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Entity Type | Individual
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Provider Name | ELISE MARIE MCCLINTOCK FNP
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5110 MIDDLEBURY COLLEGE
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City | MIDDLEBURY
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State | VT
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Zip | 05753
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Country | US
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Telephone | 802-443-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 934 NEW YORK STATE ROUTE 9N
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City | TICONDEROGA
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State | NY
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Zip | 12883
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Country | US
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Telephone | 518-585-7739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1010022133
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License Number State | VT
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