Healthcare Provider Details

I. General information

NPI: 1649274903
Provider Name (Legal Business Name): GABRIELLE HELEN MIKULA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE.
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8300
  • Fax: 802-847-1523
Mailing address:
  • Phone: 802-847-4531
  • Fax: 802-847-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0016217
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: