Provider Demographics
NPI:1881682516
Name:WORLEY, JANE M (APRN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:WORLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-1304
Mailing Address - Country:US
Mailing Address - Phone:802-430-1176
Mailing Address - Fax:949-430-1176
Practice Address - Street 1:19 GREEN MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-1241
Practice Address - Country:US
Practice Address - Phone:802-430-1176
Practice Address - Fax:949-430-1176
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0022351163WP0808X
VT101.0022351363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONS2004Medicaid
VTNS2004Medicare PIN
VTONS2004Medicaid