Individual
JACK E VISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
260 CREST RD, SUITE 101, SAINT ALBANS, VT 05478-9503
(802) 524-8805
(802) 524-8939
Mailing address
260 CREST RD, SUITE 101, SAINT ALBANS, VT 05478-9503
(802) 524-8805
(802) 524-8939
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101-0119461
VT
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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