Individual
JENNIFER APRIL CIVIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
331 UPPER PLAIN, BRADFORD, VT 05033
(802) 222-4722
(802) 222-4709
Mailing address
37 PARKHURST ST, APT 1, LEBANON, NH 03766
(603) 448-3016
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1010031684
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012431
—
VT
05
—
30344253
—
NH
Enumeration date
11/07/2006
Last updated
07/08/2007
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