Healthcare Provider Details

I. General information

NPI: 1316996127
Provider Name (Legal Business Name): JERI BRIAR WOHLBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SLAPP HILL
HARDWICK VT
05843-0535
US

IV. Provider business mailing address

165 SHERMAN DR
ST JOHNSBURY VT
05819-9811
US

V. Phone/Fax

Practice location:
  • Phone: 802-472-3300
  • Fax: 802-472-8277
Mailing address:
  • Phone: 802-748-9405
  • Fax: 802-748-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0025930
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: