Healthcare Provider Details

I. General information

NPI: 1144953290
Provider Name (Legal Business Name): SARAH ELIZABETH VREDENBURGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1878 MOUNTAIN RD STE 3
STOWE VT
05672-4775
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 802-253-4853
  • Fax: 802-888-1759
Mailing address:
  • Phone: 802-851-8619
  • Fax: 802-851-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031601
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: