1124576475 NPI number — MRS. WHITNEY P MICAL FNP

Table of content: MRS. WHITNEY P MICAL FNP (NPI 1124576475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124576475 NPI number — MRS. WHITNEY P MICAL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICAL
Provider First Name:
WHITNEY
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124576475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 SHOREHAM DEPOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORWELL
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05760-9770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-377-5977
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-2870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-447-2343
Provider Business Practice Location Address Fax Number:
802-442-4636
Provider Enumeration Date:
09/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  0122885 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 101-0122885 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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