MEDICARE: IRIS S MCDONALD CNP

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
1	363LF0000X	Family Nurse Practitioner	101-6963	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740215524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS S MCDONALD CNP

Provider Business Mailing Address
First Line	:	80 CENTRAL AVE
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 S PROSPECT ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-3456
Country	:	US
Telephone Number	:	802-847-4531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/11/2026

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