Healthcare Provider Details

I. General information

NPI: 1922994474
Provider Name (Legal Business Name): LARA CILWIK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MEDICAL VILLAGE DR
NEWPORT VT
05855-8537
US

IV. Provider business mailing address

1695 NELSON HILL RD
DERBY VT
05829-9659
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-3520
  • Fax: 802-334-3512
Mailing address:
  • Phone: 802-487-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137980
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: