Provider Demographics
NPI:1609888684
Name:WHITMORE, DURRELLE T (APNP)
Entity type:Individual
Prefix:
First Name:DURRELLE
Middle Name:T
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SKUNK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05836-9739
Mailing Address - Country:US
Mailing Address - Phone:802-533-7084
Mailing Address - Fax:
Practice Address - Street 1:720 VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:EAST CORINTH
Practice Address - State:VT
Practice Address - Zip Code:05040
Practice Address - Country:US
Practice Address - Phone:802-439-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60303523363L00000X
VT1010101436363L00000X
WI1813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1609888684Medicaid
WV43943700Medicaid
VT1023061Medicaid
VT1023061Medicaid
WIP33765Medicare UPIN
VTY400147552Medicare PIN