Healthcare Provider Details

I. General information

NPI: 1417795873
Provider Name (Legal Business Name): REBECCA PROUTY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE
BRATTLEBORO VT
05301-7601
US

IV. Provider business mailing address

37 ERNEST AVE APT 1
EXETER NH
03833-4346
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-0341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number084579-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137296
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number084579-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: