Provider Demographics
NPI:1457482101
Name:JONES, SUZANNE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COMMONS STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4601
Mailing Address - Country:US
Mailing Address - Phone:802-770-1805
Mailing Address - Fax:802-773-4876
Practice Address - Street 1:12 COMMONS STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4601
Practice Address - Country:US
Practice Address - Phone:802-770-1805
Practice Address - Fax:802-773-4876
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0030464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0AP1127Medicaid
VTAP1127Medicare ID - Type Unspecified