Healthcare Provider Details

I. General information

NPI: 1831141738
Provider Name (Legal Business Name): JACLYN A BROMLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WASHINGTON HWY STE 8
MORRISVILLE VT
05661-8716
US

IV. Provider business mailing address

530 WASHINGTON HWY STE 8
MORRISVILLE VT
05661-8716
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-8100
  • Fax:
Mailing address:
  • Phone: 802-888-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number101-0023042
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: