Individual provider Active NPI

Agnes Mikijaniec, ARNP

  • Acute Care Nurse Practitioner
  • Brattleboro, VT
National Provider Identifier
1093741571
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
026-0029155 Issued in VT
Practice address
17 Belmont Ave
Att'N: Marilyn Boudreau
Brattleboro, VT 05301-6613
Phone
(802) 257-8382
Fax
(802) 251-8466
NPI assigned
Jun 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 026-0029155 VT Primary

Addresses

Primary practice location

17 Belmont Ave
Att'N: Marilyn Boudreau
Brattleboro, VT 05301-6613

Mailing address

17 Belmont Ave
Att'N: Marilyn Boudreau
Brattleboro, VT 05301-6613
Phone (802) 257-8382

Other identifiers 2

IdentifierTypeStateIssuer
ONP3598MedicaidVT
68614OtherVTBLUE SHIELD OF VT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160329002388 VT Practitioner - Nurse Practitioner 5092778233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brattleboro Memorial HospitalGroup PAC ID 9335112929, 70 clinicians

Practice addresses (Care Compare)

19 Belmont Ave
Suite 1202
Brattleboro, VT 05301-4004
Phone (802) 251-8650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
026-0029155VTMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brattleboro Memorial Hospital CurrentSince Feb 1, 2016 Accepting new patients
Southern Vermont Health Services Corp PastSince Feb 1, 2016 Accepting new patients

Locations

19 Belmont Ave
Ste 1202
Brattleboro, VT 05301
Phone (802) 251-8650

17 Belmont Ave
Brattleboro, VT 05301
Phone (802) 257-8360

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d9dc001d-1bc5-42f9-bd4d-eb79208fd32a/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1093741571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BELMONT AVE",
            "address_2": "ATT'N: MARILYN BOUDREAU",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016613",
            "telephone_number": "802-257-8382",
            "fax_number": "802-251-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 BELMONT AVE",
            "address_2": "ATT'N: MARILYN BOUDREAU",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016613",
            "telephone_number": "802-257-8382",
            "fax_number": "802-251-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKIJANIEC",
        "first_name": "AGNES",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VT",
            "license": "026-0029155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ONP3598",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF VT",
            "identifier": "68614",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

Sources for this page

Verify at the official NPI Registry.