Provider Demographics
NPI:1992454920
Name:MAKHLINA-ECKSTEIN, TATYANA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:MAKHLINA-ECKSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:MAKHLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4447
Mailing Address - Country:US
Mailing Address - Phone:857-231-6310
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0120173163W00000X
VT101-0135467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse