Provider Demographics
NPI:1902564560
Name:DORMER, CAROLINE (NP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DORMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GREEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6054
Mailing Address - Country:US
Mailing Address - Phone:315-440-8008
Mailing Address - Fax:
Practice Address - Street 1:54 CHICKERING DR STE A
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-8805
Practice Address - Country:US
Practice Address - Phone:802-451-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134969363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health