Healthcare Provider Details

I. General information

NPI: 1932068822
Provider Name (Legal Business Name): JENNIFER JENNIFER KATSUVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BLAIR PARK RD STE 306
WILLISTON VT
05495-7855
US

IV. Provider business mailing address

600 BLAIR PARK RD STE 306
WILLISTON VT
05495-7855
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-7110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0138409
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: