1568757029 NPI number — MS. JANE PETERCUSKIE

Table of content: ROBERT PASQUALE RASPA PA-C (NPI 1508889643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568757029 NPI number — MS. JANE PETERCUSKIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERCUSKIE
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1568757029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 TAYLOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO BEND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-533-9294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 ROUTE 15 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDWICK
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-472-6961
Provider Business Practice Location Address Fax Number:
802-472-8207
Provider Enumeration Date:
06/13/2011

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: 183500000X , with the licence number:  00003461 , 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: 183500000X . This is a "PHARMACIST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com