1700139425 NPI number — DR. LAUREN MICHELLE TESSIER N.D.

Table of content: DR. CATHERINE L SMITH DO (NPI 1689060584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700139425 NPI number — DR. LAUREN MICHELLE TESSIER N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESSIER
Provider First Name:
LAUREN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

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:
1700139425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 S MAIN ST
Provider Second Line Business Mailing Address:
#2
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05676-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-560-5594
Provider Business Mailing Address Fax Number:
802-882-8157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05676-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-560-5594
Provider Business Practice Location Address Fax Number:
802-882-8157
Provider Enumeration Date:
10/18/2012

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: 175F00000X , with the licence number:  099.0090782 , 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)

  • Identifier: 1021422 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".