Provider Demographics
NPI:1306911615
Name:CLANCY, MEGHEN ANNE (PNP)
Entity type:Individual
Prefix:MS
First Name:MEGHEN
Middle Name:ANNE
Last Name:CLANCY
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Gender:F
Credentials:PNP
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Mailing Address - Street 1:ONE HOSPITAL COURT
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101
Mailing Address - Country:US
Mailing Address - Phone:802-463-3947
Mailing Address - Fax:802-463-1206
Practice Address - Street 1:HEALTH CARE AND REHABILITATION CENTER
Practice Address - Street 2:107 PARK ST
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156
Practice Address - Country:US
Practice Address - Phone:802-885-5781
Practice Address - Fax:802-885-4857
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT1010014569364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004643Medicaid
585470Medicare UPIN
VT1004643Medicaid