Healthcare Provider Details

I. General information

NPI: 1477142008
Provider Name (Legal Business Name): BRYANNE IRENE SALMONSEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST STE 400
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

61 PINE ST STE 400
BRISTOL VT
05443-1043
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-3911
  • Fax:
Mailing address:
  • Phone: 802-453-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2411
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055.0031696
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: