=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033673181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANDRA OLIVER MSN, PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2019
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 CEDAR LN
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05828-9751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-684-2275
-----------------------------------------------------
Fax | 802-695-1303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 SHERMAN DR
-----------------------------------------------------
City | ST JOHNSBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05819-9811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-748-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 95052543
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 101.0136169
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------