Provider Demographics
NPI:1154907368
Name:HASKELL, ELIZABETH SUE (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUE
Last Name:HASKELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HASKELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN/VENTILATOR SPEC
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:EAST RYEGATE
Mailing Address - State:VT
Mailing Address - Zip Code:05042-0003
Mailing Address - Country:US
Mailing Address - Phone:802-342-1765
Mailing Address - Fax:
Practice Address - Street 1:1110 WHITELAW RD
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-8929
Practice Address - Country:US
Practice Address - Phone:802-342-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0006641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse