Healthcare Provider Details

I. General information

NPI: 1982416657
Provider Name (Legal Business Name): JESSICA MILLER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 VT-110
CHELSEA VT
05038
US

IV. Provider business mailing address

PO BOX 19
VERSHIRE VT
05079-0019
US

V. Phone/Fax

Practice location:
  • Phone: 774-254-7806
  • Fax:
Mailing address:
  • Phone: 774-254-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091.0134105
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: