Healthcare Provider Details

I. General information

NPI: 1891112751
Provider Name (Legal Business Name): JESSICA OEHLKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LAKESIDE AVE UNIT 89
BURLINGTON VT
05401-5479
US

IV. Provider business mailing address

50 LAKESIDE AVE UNIT 89
BURLINGTON VT
05401-5479
US

V. Phone/Fax

Practice location:
  • Phone: 518-755-2130
  • Fax:
Mailing address:
  • Phone: 518-755-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number332272
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number042.0016252
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD463799
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: