Provider Demographics
NPI:1336469337
Name:MACLEOD, JESSICA L (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4700
Mailing Address - Fax:802-371-4720
Practice Address - Street 1:142 WOODRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4700
Practice Address - Fax:802-371-4720
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT101-0068303363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017871Medicaid
VTY400180104Medicare PIN