Provider Demographics
NPI:1487746145
Name:KELSO, MARJORIE (CNM)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:KELSO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8973
Mailing Address - Country:US
Mailing Address - Phone:802-888-8338
Mailing Address - Fax:
Practice Address - Street 1:530 WASHINGTON HIGHWAY
Practice Address - Street 2:8
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101001033367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT420001555OtherTRAVERLERS MEDICARE
VT16V120OtherMVP
VT4687201OtherVERMOND MANAGED CARE APEX
VT00039535OtherBCBS
VT0VN1944Medicaid
VT8000477OtherLADIES FIRST
VT00039535OtherBCBS