Provider Demographics
NPI:1275840712
Name:MATHIESON, SALLY KATHRYN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:KATHRYN
Last Name:MATHIESON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:4 SLAPP HL
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-9300
Practice Address - Country:US
Practice Address - Phone:802-472-3300
Practice Address - Fax:802-472-8277
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT1010063655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health