Active NPI
Ellen C Watson, APRN
- Nurse Practitioner
- Winooski, VT
National Provider Identifier
1851331508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 101023489
- Practice address
- 32 Malletts Bay Ave Ste B
Winooski, VT 05404-1960 - Phone
- (802) 655-4422
- Fax
- (802) 861-2678
- NPI assigned
- Jun 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 101023489 | VT | Primary |
Addresses
Primary practice location
32 Malletts Bay Ave Ste B
Winooski, VT 05404-1960
Mailing address
32 Malletts Bay Ave Ste B
Winooski, VT 05404-1960
Phone (802) 655-4422
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 69295 | Other | VT | VERMONT MANAGED CARE |
| 69295 | Other | VT | BLUE CROSS BLUE SHIELD |
| 1012575 | Medicaid | VT | |
| 0023489 | Other | VT | FLETCHER ALLEN PREFERRED |
| 389625 | Other | VT | MVP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101023489 | VT | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1851331508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 MALLETTS BAY AVE STE B",
"city": "WINOOSKI",
"state": "VT",
"postal_code": "054041960",
"telephone_number": "802-655-4422",
"fax_number": "802-861-2678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 MALLETTS BAY AVE STE B",
"city": "WINOOSKI",
"state": "VT",
"postal_code": "054041960",
"telephone_number": "802-655-4422",
"fax_number": "802-861-2678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "ELLEN",
"middle_name": "C",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-08",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "VT",
"license": "101023489",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VERMONT MANAGED CARE",
"identifier": "69295",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "69295",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1012575",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLETCHER ALLEN PREFERRED",
"identifier": "0023489",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "389625",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winooski, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.