Healthcare Provider Details

I. General information

NPI: 1790293777
Provider Name (Legal Business Name): JAMIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 VT RTE 7A
SHAFTSBURY VT
05262-0379
US

IV. Provider business mailing address

PO BOX 379
SHAFTSBURY VT
05262-0379
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8531
  • Fax: 802-442-1503
Mailing address:
  • Phone: 802-442-8531
  • Fax: 802-442-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number101.0130340
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: