Provider Demographics
NPI:1114992518
Name:MCDONALD, MARILYN T (APRN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:T
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9635
Mailing Address - Country:US
Mailing Address - Phone:802-775-0661
Mailing Address - Fax:
Practice Address - Street 1:9 HAYWOOD AVE
Practice Address - Street 2:MOUNTAIN VIEW CENTER
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4832
Practice Address - Country:US
Practice Address - Phone:802-775-0007
Practice Address - Fax:802-775-6895
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0019819363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0905Medicaid
VTNP0905Medicare ID - Type Unspecified
VT0NP0905Medicaid