Provider Demographics
NPI:1750471561
Name:WHITCOMB, HOLLY T (APRN NP FNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:T
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:APRN NP FNP
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 250
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461
Mailing Address - Country:US
Mailing Address - Phone:802-482-3200
Mailing Address - Fax:802-482-5238
Practice Address - Street 1:22 COMMERCE ST
Practice Address - Street 2:UNIT 10
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461
Practice Address - Country:US
Practice Address - Phone:802-482-3200
Practice Address - Fax:802-482-5238
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010023428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009171Medicaid
VT68575OtherBCBS OF VT
361502OtherMVP
361502OtherMVP
VTWHNP3842Medicare ID - Type Unspecified