Healthcare Provider Details

I. General information

NPI: 1972517969
Provider Name (Legal Business Name): JANET STILES MCSORLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAIN PAVILION-LEVEL 5 VASCULAR
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

E14 STONEHEDGE DR
SOUTH BURLINGTON VT
05403-7367
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4548
  • Fax: 802-847-0970
Mailing address:
  • Phone: 802-657-4189
  • Fax: 802-847-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number101-0014545
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: