Healthcare Provider Details

I. General information

NPI: 1508785437
Provider Name (Legal Business Name): JESSICA LYN TREMBLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MAIN ST N
WELLS RIVER VT
05081-9692
US

IV. Provider business mailing address

1149 ROUTE 132
THETFORD CENTER VT
05075-8782
US

V. Phone/Fax

Practice location:
  • Phone: 802-757-2325
  • Fax:
Mailing address:
  • Phone: 802-272-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0139566
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: