Healthcare Provider Details

I. General information

NPI: 1033692850
Provider Name (Legal Business Name): ALEXA RUPPERT HOLLERAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 PARTRIDGE HL
NORWICH VT
05055-9637
US

IV. Provider business mailing address

66 PARTRIDGE HL
NORWICH VT
05055-9637
US

V. Phone/Fax

Practice location:
  • Phone: 802-825-8588
  • Fax:
Mailing address:
  • Phone: 802-825-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number074620-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number074620-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: