Provider Demographics
NPI:1972985745
Name:WELLS, ELISABETH B (NP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:B
Last Name:WELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:CONDE
Other - Last Name:BICKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATTN: CVMC FINANCE DEPT.
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-496-3838
Mailing Address - Fax:802-496-5586
Practice Address - Street 1:859 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673-6221
Practice Address - Country:US
Practice Address - Phone:802-496-3838
Practice Address - Fax:802-496-5586
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0109743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily