Provider Demographics
NPI:1598462103
Name:ORMROD-LEVEN, JADE LILY
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LILY
Last Name:ORMROD-LEVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-8983
Mailing Address - Country:US
Mailing Address - Phone:802-299-9722
Mailing Address - Fax:
Practice Address - Street 1:406 1ST AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-8983
Practice Address - Country:US
Practice Address - Phone:802-299-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031708363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical