Individual
MARY JAEGER STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5957 MAIN ST, NORTHSHIRE MEDICAL CENTER, MANCHESTER CENTER, VT 05255-8913
(802) 362-4440
(802) 362-7146
Mailing address
5957 MAIN STREET, NORTHSHIRE MEDICAL CENTER, MANCHESTER, VT 05255
(802) 362-4440
(802) 362-7146
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101-0019775
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0NP1782
—
VT
Enumeration date
04/25/2006
Last updated
01/13/2014
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