Provider Demographics
NPI:1861433500
Name:BOARDMAN, MAUREEN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-0008
Mailing Address - Country:US
Mailing Address - Phone:802-222-3026
Mailing Address - Fax:888-462-0883
Practice Address - Street 1:437 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9196
Practice Address - Country:US
Practice Address - Phone:802-222-9317
Practice Address - Fax:888-462-0883
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0010030382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTP00343208OtherRAIL ROAD MEDICARE
VT0NP2958Medicaid
VTVX1773Medicare PIN
VTNP2958Medicare PIN
VTH92764Medicare UPIN
VT0NP2958Medicaid
H92764Medicare PIN