Healthcare Provider Details

I. General information

NPI: 1497451587
Provider Name (Legal Business Name): LAUREN SHOCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 HOUGHTON BROOK RD
PUTNEY VT
05346-8675
US

IV. Provider business mailing address

PO BOX 110
PUTNEY VT
05346-0110
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-0164
  • Fax: 802-387-6228
Mailing address:
  • Phone: 802-387-0164
  • Fax: 802-387-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0136052
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: