Provider Demographics
NPI:1770505661
Name:VETERANS HOSPITAL, WRJ
Entity Type:Organization
Organization Name:VETERANS HOSPITAL, WRJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL PA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:802-295-9363
Mailing Address - Street 1:166 EDSON BURKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-4411
Mailing Address - Country:US
Mailing Address - Phone:802-484-7897
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH343363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty