Healthcare Provider Details

I. General information

NPI: 1225638299
Provider Name (Legal Business Name): ALYSSA MARY BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S MAIN ST
RUTLAND VT
05701-4713
US

IV. Provider business mailing address

102 NORTH ST
BRISTOL CT
06010-4190
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-4165
  • Fax:
Mailing address:
  • Phone: 860-314-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137669
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: