Provider Demographics
NPI:1295376663
Name:ECKLUND, MARINA M (APRN)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:M
Last Name:ECKLUND
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 1:313 S WINOOSKI AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4543
Mailing Address - Country:US
Mailing Address - Phone:802-279-3358
Mailing Address - Fax:
Practice Address - Street 1:1 ALDEN PL
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1102
Practice Address - Country:US
Practice Address - Phone:802-222-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134141363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health