Healthcare Provider Details

I. General information

NPI: 1033446216
Provider Name (Legal Business Name): ERIN ANNE LOSKUTOFF RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 VILLAGE ROAD
EAST CORINTH VT
05040
US

IV. Provider business mailing address

720 VILLAGE ROAD
EAST CORINTH VT
05040
US

V. Phone/Fax

Practice location:
  • Phone: 802-439-5321
  • Fax: 802-439-6783
Mailing address:
  • Phone: 802-439-5321
  • Fax: 802-439-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0117769
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number101.0117769
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: