Healthcare Provider Details

I. General information

NPI: 1366756686
Provider Name (Legal Business Name): PAULETTE J THABAULT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 DORSET ST SUITE 1
SOUTH BURLINGTON VT
05403-6236
US

IV. Provider business mailing address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-1441
  • Fax: 802-860-4646
Mailing address:
  • Phone: 802-864-6309
  • Fax: 802-860-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1010010736
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: