Provider Demographics
NPI:1225094113
Name:HESS, MARIEL K (FNP)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:K
Last Name:HESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 PERRON HL
Mailing Address - Street 2:
Mailing Address - City:GLOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05839-9742
Mailing Address - Country:US
Mailing Address - Phone:802-525-6638
Mailing Address - Fax:
Practice Address - Street 1:2980 PERRON HL
Practice Address - Street 2:
Practice Address - City:GLOVER
Practice Address - State:VT
Practice Address - Zip Code:05839-9742
Practice Address - Country:US
Practice Address - Phone:802-525-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010012178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008902Medicaid
VTNP0508Medicare ID - Type UnspecifiedMEDICARE
VT0008902Medicaid