Healthcare Provider Details

I. General information

NPI: 1487173860
Provider Name (Legal Business Name): KAMERON ESCAJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 09/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LAKESIDE AVE STE 260
BURLINGTON VT
05401-5911
US

IV. Provider business mailing address

47 LAMELL AVE
ESSEX JUNCTION VT
05452-2714
US

V. Phone/Fax

Practice location:
  • Phone: 802-657-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0128797
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: