Healthcare Provider Details

I. General information

NPI: 1295503084
Provider Name (Legal Business Name): LOUISA VEAZIE PRATT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PORTER DR
MIDDLEBURY VT
05753-8423
US

IV. Provider business mailing address

224 SHERIDAN ST
PORTLAND ME
04101-2638
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-4701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF12230507
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number026.0113602
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: