Provider Demographics
NPI:1053745562
Name:SHATTUCK, MAUREEN (RN,CDE)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SHATTUCK
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:BARTON / MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-886-8988
Mailing Address - Fax:802-886-8909
Practice Address - Street 1:100 RIVER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2930
Practice Address - Country:US
Practice Address - Phone:802-886-8988
Practice Address - Fax:802-886-8909
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0021192163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator