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2948 Vt Route 100 Jacksonville VT 05342-9510 | |
(802) 435-0616 | |
Not Available |
Full Name | |
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Speciality | Nurse Practitioner |
Location | 2948 Vt Route 100, Jacksonville, Vermont |
Authorized Official Name and Position | Wendy Ann Sergeant (PRESIDENT) |
Authorized Official Contact | 8024350616 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 576 Jacksonville VT 05342-0576 Ph: (508) 637-1604 | 2948 Vt Route 100 Jacksonville VT 05342-9510 Ph: (802) 435-0616 |
NPI Number | 1124250352 |
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Provider Enumeration Date | 08/21/2009 |
Last Update Date | 08/23/2022 |
Certification Date | 08/23/2022 |
Medicare PECOS PAC ID | 3779621040 |
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Medicare Enrollment ID | O20091105000552 |
Identifier | Type | State | Issuer |
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1124250352 | NPI | - | NPPES |
Provider Name | Wendy Sergeant |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871687459 PECOS PAC ID: 1850483835 Enrollment ID: I20070822000834 |
Provider Name | Albert Byron Olivera |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336782275 PECOS PAC ID: 7416369681 Enrollment ID: I20201211000407 |