1164943692 NPI number — ANDREW SEMEGRAM APRN, FNP-C, CEN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164943692 NPI number — ANDREW SEMEGRAM APRN, FNP-C, CEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMEGRAM
Provider First Name:
ANDREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C, CEN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164943692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 ATKINSON ST APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLOWS FALLS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05101-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-693-3999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWNSHEND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05353-0216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-365-7676
Provider Business Practice Location Address Fax Number:
802-365-7294
Provider Enumeration Date:
07/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  101.0130940 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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