Provider Demographics
NPI:1114499738
Name:CHIARAVALLE, DOROTHY (FNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:CHIARAVALLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7855
Mailing Address - Country:US
Mailing Address - Phone:802-228-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:19 BELMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6761
Practice Address - Country:US
Practice Address - Phone:802-258-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602449163WX0200X
NY345985363LF0000X
VT101.0136453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology