Provider Demographics
NPI:1649274903
Name:MIKULA, GABRIELLE HELEN (APRN)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:HELEN
Last Name:MIKULA
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 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4531
Mailing Address - Fax:802-847-8510
Practice Address - Street 1:111 COLCHESTER AVE.
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-8300
Practice Address - Fax:802-847-1523
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0016217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT7950468OtherCIGNA
VT28925OtherBC/BS
VTONP0890Medicaid
VT12V001OtherMVP INSURANCE NUMBER
VTONP0890Medicaid
VT12V001OtherMVP INSURANCE NUMBER