Provider Demographics
NPI:1205560646
Name:BRUYETTE, VICTORIA (APRN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BRUYETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHITTENDEN
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9657
Mailing Address - Country:US
Mailing Address - Phone:719-650-5412
Mailing Address - Fax:
Practice Address - Street 1:855 SOUTH BARRE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BARRE
Practice Address - State:VT
Practice Address - Zip Code:05670
Practice Address - Country:US
Practice Address - Phone:802-301-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999843-NP363LP0808X
VT101.0135479363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000236286Medicaid