Basic Information
| Provider Information | |||||||||
| NPI: | 1770596991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONEY-EVANS | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 547 | ||||||||
| Address2: | CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT | ||||||||
| City: | BARRE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056410547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024854161 | ||||||||
| FaxNumber: | 8024854163 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 PAINE MOUNTAIN DRIVE | ||||||||
| Address2: | GREEN MOUNTAIN FAMILY PRACTICE | ||||||||
| City: | NORTHFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056630000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024854161 | ||||||||
| FaxNumber: | 8024854163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 101.0017795 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SF0001X | 101-0017795 | VT | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
ID Information
| ID | Type | State | Issuer | Description | 00048789 | 01 | VT | BLUE CROSS | OTHER | 0NP2112 | 05 | VT | MEDICAID | 8000179 | 01 | VT | LADIES FIRST | OTHER |