Provider Demographics
NPI:1609972306
Name:OWEN, ELAINE BEAUDOIN (APRN,AOCN,MSN)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:BEAUDOIN
Last Name:OWEN
Suffix:
Gender:F
Credentials:APRN,AOCN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5400
Mailing Address - Fax:802-225-5401
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:MOB-B SUITE 3
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-5400
Practice Address - Fax:802-225-5401
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12633363L00000X
VT1010012633363L00000X
VT101.0012633364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONS2011Medicaid
VTNS2011Medicare PIN
VTNS201102Medicare PIN