Provider Demographics
NPI:1013973858
Name:RATHBURN, JENIANE L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENIANE
Middle Name:L
Last Name:RATHBURN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENIANE
Other - Middle Name:L
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DANIELS
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:201 E MAIN STREET
Practice Address - Street 2:CONCORD HEALTH CENTER
Practice Address - City:CONCORD
Practice Address - State:VT
Practice Address - Zip Code:05824-0355
Practice Address - Country:US
Practice Address - Phone:802-695-2512
Practice Address - Fax:802-695-1303
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550031134363AM0700X
VT0550030707363AM0700X
VT0550030914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000181Medicaid
VT9000181Medicaid
VTQ18262Medicare UPIN
AP2113Medicare PIN