Provider Demographics
NPI:1568688190
Name:DICK, EILEEN STOCKMAN (RNC,NP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:STOCKMAN
Last Name:DICK
Suffix:
Gender:F
Credentials:RNC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9123
Mailing Address - Country:US
Mailing Address - Phone:802-773-8842
Mailing Address - Fax:802-773-4666
Practice Address - Street 1:372 SUNSET DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-9123
Practice Address - Country:US
Practice Address - Phone:802-773-8842
Practice Address - Fax:802-773-4666
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0007914363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health