Provider Demographics
NPI:1043409675
Name:DOUGLAS, HELLA (APRN BC ADULT PSYCH)
Entity Type:Individual
Prefix:MRS
First Name:HELLA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:APRN BC ADULT PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7519
Mailing Address - Country:US
Mailing Address - Phone:802-318-7466
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-318-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010020560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health