Provider Demographics
NPI:1013211481
Name:LOURIE, JEFFREY W (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:LOURIE
Suffix:
Gender:M
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COURT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2854
Mailing Address - Country:US
Mailing Address - Phone:802-828-1234
Mailing Address - Fax:802-760-6286
Practice Address - Street 1:7 COURT ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2856
Practice Address - Country:US
Practice Address - Phone:802-828-1234
Practice Address - Fax:802-760-6286
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER055703163W00000X
VT026.0097231163W00000X
MEAP101078363LF0000X
VT101.0095764363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP101078OtherANP
MER055703OtherRN
VT101.0095764OtherVERMONT BOARD OF NURSING