MEDICARE: MELISSA J PROUTY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	101.0072089	VT

General Provider Information

NPI Number	:	1568772747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA J PROUTY FNP

Provider Business Mailing Address
First Line	:	483 HIDDEN VALLEY RD
Second Line	:
City	:	SHAFTSBURY
State	:	VT
Zip	:	05262-9478
Country	:	US
Telephone Number	:	802-447-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 CHURCH ST
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-4457
Country	:	US
Telephone Number	:	802-375-6566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	07/20/2023

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