Healthcare Provider Details

I. General information

NPI: 1568772747
Provider Name (Legal Business Name): MELISSA J PROUTY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CHURCH ST
ARLINGTON VT
05250-4457
US

IV. Provider business mailing address

483 HIDDEN VALLEY RD
SHAFTSBURY VT
05262-9478
US

V. Phone/Fax

Practice location:
  • Phone: 802-375-6566
  • Fax:
Mailing address:
  • Phone: 802-447-1173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0072089
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: