Healthcare Provider Details

I. General information

NPI: 1083519201
Provider Name (Legal Business Name): KATRINA BOISSONNAULT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 RT 103 S
CHESTER VT
05143
US

IV. Provider business mailing address

301 VT 11
CHESTER VT
05143-4400
US

V. Phone/Fax

Practice location:
  • Phone: 802-875-4154
  • Fax:
Mailing address:
  • Phone: 802-591-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number026.0094999
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: