Provider Demographics
NPI:1710374582
Name:RUOT-JACKSON, DAWNE (ADN RN)
Entity Type:Individual
Prefix:
First Name:DAWNE
Middle Name:
Last Name:RUOT-JACKSON
Suffix:
Gender:F
Credentials:ADN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:1 HOSPITAL COURT SUITE 2
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101
Practice Address - Country:US
Practice Address - Phone:802-463-3947
Practice Address - Fax:802-463-1202
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE54127163W00000X
VT026.0110493163W00000X
NH071368-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE2534Medicare PIN