Basic Information
| Provider Information | |||||||||
| NPI: | 1790956738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALCOLM | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056610749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028518704 | ||||||||
| FaxNumber: | 8024965586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1878 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056724776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022534853 | ||||||||
| FaxNumber: | 8024965586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 039145-23 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | 039145-23 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LF0000X | 1010021863 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | VN200903 | 01 | VT | MEDICARE PTAN LINKED TO CVMC MGP | OTHER | 0NP0315 | 05 | VT | MEDICAID |