Provider Demographics
NPI:1770596991
Name:MALONEY-EVANS, DEBRA (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MALONEY-EVANS
Suffix:
Gender:F
Credentials:NP
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 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-485-4161
Mailing Address - Fax:802-485-4163
Practice Address - Street 1:87 PAINE MOUNTAIN DRIVE
Practice Address - Street 2:GREEN MOUNTAIN FAMILY PRACTICE
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-0000
Practice Address - Country:US
Practice Address - Phone:802-485-4161
Practice Address - Fax:802-485-4163
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0017795363LF0000X
VT101-0017795364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00048789OtherBLUE CROSS
VT0NP2112Medicaid
VT8000179OtherLADIES FIRST
VT0NP2112Medicaid
VTY400214242Medicare PIN