Provider Demographics
NPI:1033673181
Name:OLIVER, JANDRA (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JANDRA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:
Practice Address - Street 1:26 CEDAR LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828-9751
Practice Address - Country:US
Practice Address - Phone:802-684-2275
Practice Address - Fax:802-695-1303
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95052543163WP0808X
390200000X
VT101.0136169363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program