Healthcare Provider Details

I. General information

NPI: 1598741019
Provider Name (Legal Business Name): ELISA BRETTLER VANDERVORT FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAIN CAMPUS, MAIN PAVILION, LEVEL 4
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1400
  • Fax: 802-847-8433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0026277
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number101-0026277
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: