Provider Demographics
NPI:1174252076
Name:MATTHEW MIFFITT, APRN, PLC
Entity Type:Organization
Organization Name:MATTHEW MIFFITT, APRN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MIFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-242-1262
Mailing Address - Street 1:875 ROOSEVELT HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4460
Mailing Address - Country:US
Mailing Address - Phone:802-242-1262
Mailing Address - Fax:802-495-5539
Practice Address - Street 1:875 ROOSEVELT HWY STE 220
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4460
Practice Address - Country:US
Practice Address - Phone:802-242-1262
Practice Address - Fax:802-495-5539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEW MIFFITT, APRN, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty