Provider Demographics
NPI:1003840968
Name:DOUGLAS, MARJORIE E (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:E
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials: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 38
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-0038
Mailing Address - Country:US
Mailing Address - Phone:802-425-2781
Mailing Address - Fax:
Practice Address - Street 1:527 FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9555
Practice Address - Country:US
Practice Address - Phone:802-425-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010006857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily