Provider Demographics
NPI:1326029893
Name:WACHTEL, DEBORAH S (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-3980
Mailing Address - Fax:802-371-4855
Practice Address - Street 1:130 FISHER RD UNIT 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9000
Practice Address - Country:US
Practice Address - Phone:802-225-3980
Practice Address - Fax:802-371-4855
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0014969363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTNP292601OtherMEDICARE PTAN LINKED TO VN3891
VTONP2926Medicaid
VT101-0014969OtherAPRN LICENSE
VT101-0014969OtherAPRN LICENSE
VT101-0014969OtherAPRN LICENSE
VTP20569Medicare UPIN