Provider Demographics
NPI:1831433135
Name:FUNK-WEYANT, JENNIFFER L (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:L
Last Name:FUNK-WEYANT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:CVMC FAMILY MEDICINE BERLIN
Mailing Address - Street 2:246 GRANGER ROAD SUITE 2
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-255-5810
Mailing Address - Fax:802-371-4821
Practice Address - Street 1:246 GRANGER RD STE 2
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5352
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2019-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT1010134202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1035031Medicaid