Provider Demographics
NPI:1508199027
Name:VASQUEZ-BROWN, CARLENE M (APRN)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:M
Last Name:VASQUEZ-BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:M
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4372 VT ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:VT
Mailing Address - Zip Code:05674-9728
Mailing Address - Country:US
Mailing Address - Phone:802-744-7284
Mailing Address - Fax:949-437-3084
Practice Address - Street 1:4372 VT ROUTE 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:VT
Practice Address - Zip Code:05674-9728
Practice Address - Country:US
Practice Address - Phone:802-744-7284
Practice Address - Fax:949-437-3084
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053492-23363LA2200X
VT101.0135001363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30347680Medicaid
NH30347680Medicaid