Provider Demographics
NPI:1912301193
Name:WASMUS, LENA (APRN)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:WASMUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 EXCHANGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4464
Mailing Address - Country:US
Mailing Address - Phone:802-855-2027
Mailing Address - Fax:802-855-2053
Practice Address - Street 1:1330 EXCHANGE ST STE 201
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4464
Practice Address - Country:US
Practice Address - Phone:802-855-2027
Practice Address - Fax:802-855-2053
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0101390163W00000X
VT101-0107739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024132Medicaid
NY04088579Medicaid
VT1024132Medicaid