Provider Demographics
NPI:1780411223
Name:ONEBREATH VERMONT PLLC
Entity type:Organization
Organization Name:ONEBREATH VERMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:802-793-8636
Mailing Address - Street 1:28 PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9701
Mailing Address - Country:US
Mailing Address - Phone:802-498-8123
Mailing Address - Fax:
Practice Address - Street 1:28 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-498-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty