Basic Information
Provider Information | |||||||||
NPI: | 1124576475 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MICAL | ||||||||
FirstName: | WHITNEY | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 27 SHOREHAM DEPOT RD | ||||||||
Address2: |   | ||||||||
City: | ORWELL | ||||||||
State: | VT | ||||||||
PostalCode: | 057609770 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8023775977 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 655 MAIN ST | ||||||||
Address2: | SUITE 1 | ||||||||
City: | BENNINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 052012870 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8024472343 | ||||||||
FaxNumber: | 8024424636 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/15/2016 | ||||||||
LastUpdateDate: | 12/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 0122885 | VT | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | 101-0122885 | VT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.