Basic Information
| Provider Information | |||||||||
| NPI: | 1588168884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | NESBITT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E 70TH STREET | ||||||||
| Address2: | LASDON HOUSE APT14D1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603032884 | ||||||||
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| Practice Location | |||||||||
| Address1: | UVMMC 111 COLCHESTER AVENUE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 042-0015372 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.