Healthcare Provider Details

I. General information

NPI: 1326029893
Provider Name (Legal Business Name): DEBORAH S WACHTEL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD UNIT 1
BERLIN VT
05602-9000
US

IV. Provider business mailing address

PO BOX 547
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-3980
  • Fax: 802-371-4855
Mailing address:
  • Phone: 802-225-3980
  • Fax: 802-371-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101-0014969
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number101-0014969
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: