Provider Demographics
NPI:1508054354
Name:GEOFFRION, JILL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GEOFFRION
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:57 FAYETTE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6964
Mailing Address - Country:US
Mailing Address - Phone:802-658-5756
Mailing Address - Fax:802-865-0042
Practice Address - Street 1:57 FAYETTE DR STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6964
Practice Address - Country:US
Practice Address - Phone:802-658-5756
Practice Address - Fax:802-865-0042
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031083363A00000X, 363A00000X
NC0010-01069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant