Provider Demographics
NPI:1477142008
Name:SALMONSEN, BRYANNE IRENE (PA)
Entity type:Individual
Prefix:
First Name:BRYANNE
Middle Name:IRENE
Last Name:SALMONSEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PINE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1043
Mailing Address - Country:US
Mailing Address - Phone:802-453-3911
Mailing Address - Fax:
Practice Address - Street 1:61 PINE ST STE 400
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2411363A00000X
VT055.0031696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty