Healthcare Provider Details

I. General information

NPI: 1467165852
Provider Name (Legal Business Name): GAYLEN ALEXANDER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BURNHAM AVE
RUTLAND VT
05701-3205
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 866-476-1321
  • Fax: 802-775-2044
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135920
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: