Healthcare Provider Details

I. General information

NPI: 1972120129
Provider Name (Legal Business Name): JACQUELYN SCHNACKEL PORZUCEK APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN FAIN SCHNACKEL APRN-CNP

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2370
  • Fax: 802-847-8590
Mailing address:
  • Phone: 802-847-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number026.0152967
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number101.0136923
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: