1750471561 NPI number — MRS. HOLLY T WHITCOMB APRN NP FNP

Table of content: MRS. HOLLY T WHITCOMB APRN NP FNP (NPI 1750471561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750471561 NPI number — MRS. HOLLY T WHITCOMB APRN NP FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITCOMB
Provider First Name:
HOLLY
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN NP FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750471561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINESBURG
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-482-3200
Provider Business Mailing Address Fax Number:
802-482-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 COMMERCE ST
Provider Second Line Business Practice Location Address:
UNIT 10
Provider Business Practice Location Address City Name:
HINESBURG
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-482-3200
Provider Business Practice Location Address Fax Number:
802-482-5238
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1010023428 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1009171 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68575 . This is a "BCBS OF VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 361502 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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