Healthcare Provider Details

I. General information

NPI: 1205560646
Provider Name (Legal Business Name): VICTORIA BRUYETTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BECKLEY HILL RD
BARRE VT
05641-9080
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-476-1480
  • Fax: 802-479-4095
Mailing address:
  • Phone: 802-229-1399
  • Fax: 802-223-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0135479
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999843-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: