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NPI Code Detail

MEDICARE: MRS. MARJORIE E. DOUGLAS FNP

MEDICARE: MRS. MARJORIE E. DOUGLAS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1010006857VT

General Provider Information

NPI Number : 1003840968
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARJORIE E. DOUGLAS FNP
Provider Business Mailing Address
First Line : PO BOX 38
Second Line :
City : CHARLOTTE
State : VT
Zip : 05445-0038
Country : US
Telephone Number : 802-425-2781
Fax Number :
Provider Business Practice Location Address
First Line : 527 FERRY RD
Second Line :
City : CHARLOTTE
State : VT
Zip : 05445-9555
Country : US
Telephone Number : 802-425-2781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/08/2007

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