Healthcare Provider Details

I. General information

NPI: 1780219063
Provider Name (Legal Business Name): ALISSA WARSHAW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 BLAIR PARK RD
WILLISTON VT
05495-7530
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3330
  • Fax: 802-847-0733
Mailing address:
  • Phone: 802-847-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134497
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: