Healthcare Provider Details

I. General information

NPI: 1912911793
Provider Name (Legal Business Name): KAREN M PETRUNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 ROUTE 11
LONDONDERRY VT
05148-9555
US

IV. Provider business mailing address

2141 TWENTY MILE STREAM RD
PROCTORSVILLE VT
05153-9716
US

V. Phone/Fax

Practice location:
  • Phone: 802-824-6901
  • Fax:
Mailing address:
  • Phone: 203-819-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001905
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: