Healthcare Provider Details

I. General information

NPI: 1780319269
Provider Name (Legal Business Name): STEPHANIE ANN LAROZA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN MCCLURE

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HOSPITAL DR
ST JOHNSBURY VT
05819-6001
US

IV. Provider business mailing address

1080 HOSPITAL DR
ST JOHNSBURY VT
05819-6001
US

V. Phone/Fax

Practice location:
  • Phone: 802-473-4100
  • Fax:
Mailing address:
  • Phone: 802-473-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number073555-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number073555-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135591
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: