Healthcare Provider Details

I. General information

NPI: 1508199027
Provider Name (Legal Business Name): CARLENE M VASQUEZ-BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLENE M MITCHELL APRN

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4372 VT ROUTE 100
WARREN VT
05674-9728
US

IV. Provider business mailing address

4372 VT ROUTE 100
WARREN VT
05674-9728
US

V. Phone/Fax

Practice location:
  • Phone: 802-744-7284
  • Fax: 949-437-3084
Mailing address:
  • Phone: 802-744-7284
  • Fax: 949-437-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number053492-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0135001
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: