Provider Demographics
NPI:1619218930
Name:NORRIS, ALICE (RN,IBCLC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:RN,IBCLC
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 72
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05462-0072
Mailing Address - Country:US
Mailing Address - Phone:802-488-5153
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-488-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VT11180095163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies