Provider Demographics
NPI:1679526230
Name:ERNST, CAROLYNN
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:
Last Name:ERNST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-9236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 PARK ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3032
Practice Address - Country:US
Practice Address - Phone:802-885-4701
Practice Address - Fax:802-885-5440
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010013152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4000028Medicaid
VTS60717Medicare UPIN
VTNP1296Medicare ID - Type UnspecifiedMEDICARE