Healthcare Provider Details

I. General information

NPI: 1710374582
Provider Name (Legal Business Name): DAWNE RUOT-JACKSON ADN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL COURT SUITE 2
BELLOWS FALLS VT
05101
US

IV. Provider business mailing address

390 RIVER ST
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-463-3947
  • Fax: 802-463-1202
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE54127
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0110493
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number071368-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: