Healthcare Provider Details

I. General information

NPI: 1205458056
Provider Name (Legal Business Name): ELISA VAUTIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 BLAIR PARK RD
WILLISTON VT
05495-7530
US

IV. Provider business mailing address

14 MEADOWVIEW DR
HUNTINGTON VT
05462-9516
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1470
  • Fax:
Mailing address:
  • Phone: 406-599-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0134562
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number101.0134562
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0132550
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: