Provider Demographics
NPI:1811935430
Name:STEPHANI, PASCALE C (FNP)
Entity type:Individual
Prefix:
First Name:PASCALE
Middle Name:C
Last Name:STEPHANI
Suffix:
Gender:F
Credentials:FNP
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 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5810
Mailing Address - Fax:802-371-4821
Practice Address - Street 1:246 GRANGER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-0000
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4780074363LF0000X
VT101.0062975363LF0000X
UT47800744402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017218Medicaid
P92363Medicare UPIN
001478101Medicare PIN
UT005566105Medicare ID - Type Unspecified