Healthcare Provider Details

I. General information

NPI: 1174276067
Provider Name (Legal Business Name): ELISE KATHLEEN SAWYER KRAUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GRAFTON RD
TOWNSHEND VT
05353-8820
US

IV. Provider business mailing address

185 GRAFTON RD
TOWNSHEND VT
05353-8820
US

V. Phone/Fax

Practice location:
  • Phone: 603-762-3303
  • Fax:
Mailing address:
  • Phone: 802-365-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0135267
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0135267
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0111722
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number066132-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: