Provider Demographics
NPI:1922994474
Name:CILWIK, LARA (FNP)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:CILWIK
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 1:1695 NELSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829-9659
Mailing Address - Country:US
Mailing Address - Phone:802-487-4980
Mailing Address - Fax:
Practice Address - Street 1:186 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8537
Practice Address - Country:US
Practice Address - Phone:802-334-3520
Practice Address - Fax:802-334-3512
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0137980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily