Healthcare Provider Details

I. General information

NPI: 1750060950
Provider Name (Legal Business Name): MADELINE DUBOIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE BUCKLEY

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

81 HALL ST
WINOOSKI VT
05404-1738
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number026.0146876
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0137297
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: