Healthcare Provider Details

I. General information

NPI: 1750204343
Provider Name (Legal Business Name): JESSICA J. BOEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

IV. Provider business mailing address

PO BOX 128
EAST THETFORD VT
05043-0128
US

V. Phone/Fax

Practice location:
  • Phone: 802-440-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0139646
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: