Healthcare Provider Details

I. General information

NPI: 1477151231
Provider Name (Legal Business Name): NICOLE VALCOUR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MAIN ST APT 27
MONTPELIER VT
05602-2987
US

IV. Provider business mailing address

553 N MAIN ST
BARRE VT
05641-2501
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-8355
  • Fax: 802-223-8105
Mailing address:
  • Phone: 802-479-1229
  • Fax: 802-479-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134673
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0134671
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number026.0020728
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: