Provider Demographics
NPI:1558684845
Name:PINELES-MARK, ERIKA-KRISTINA BRADSTREET (WHNP / CNM)
Entity Type:Individual
Prefix:MS
First Name:ERIKA-KRISTINA
Middle Name:BRADSTREET
Last Name:PINELES-MARK
Suffix:
Gender:F
Credentials:WHNP / CNM
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Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-5961
Mailing Address - Fax:802-371-5960
Practice Address - Street 1:130 FISHER RD STE 1-1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8132
Practice Address - Country:US
Practice Address - Phone:802-371-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC1013296363LW0102X, 367A00000X
VT101.0135051367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife