Provider Demographics
NPI:1740972173
Name:ROBILLARD, JAMIE NICOLE (MSN RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:N
Other - Last Name:MAXHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:VT
Mailing Address - Zip Code:05038-8931
Mailing Address - Country:US
Mailing Address - Phone:802-272-1821
Mailing Address - Fax:
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:575-894-3221
Practice Address - Fax:575-894-4999
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0113508163W00000X
NM74023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse