Provider Demographics
NPI:1497986855
Name:FIDLER, MAXINE ELIZABETH (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:ELIZABETH
Last Name:FIDLER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:ELIZABETH
Other - Last Name:HUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 OTTERSIDE COURT NORTH
Mailing Address - Street 2:#24
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-349-0440
Mailing Address - Fax:
Practice Address - Street 1:31 COURT STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-349-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT171100000X
VT099-0000256175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist