Basic Information
Provider Information | |||||||||
NPI: | 1336424845 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SYLVESTER | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | JEAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BROWN | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: | JEAN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 32 | ||||||||
Address2: | PROCLAIM INC | ||||||||
City: | ANDOVER | ||||||||
State: | NH | ||||||||
PostalCode: | 032160032 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6037356060 | ||||||||
FaxNumber: | 6037356070 | ||||||||
Practice Location | |||||||||
Address1: | 580 ST. JOHNSBURY RD | ||||||||
Address2: |   | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 03561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034449000 | ||||||||
FaxNumber: | 8022296645 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/15/2011 | ||||||||
LastUpdateDate: | 08/21/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 101.0080472 | VT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 1019875 | 05 | VT |   | MEDICAID |