Provider Demographics
NPI:1669019949
Name:BRIGANTE, ELIZABETH (LICENSED COSMATIC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BRIGANTE
Suffix:
Gender:F
Credentials:LICENSED COSMATIC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DRENNIALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 734
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251
Mailing Address - Country:US
Mailing Address - Phone:802-922-8969
Mailing Address - Fax:
Practice Address - Street 1:4351 ROUTE 7A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-922-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT102.0133720171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor