Basic Information
| Provider Information | |||||||||
| NPI: | 1750819371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARITEAU | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 219 | ||||||||
| Address2: | |||||||||
| City: | BARRE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056410219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024772024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 FISHER RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056029516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023714264 | ||||||||
| FaxNumber: | 8023714481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2017 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1010127420 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1030785 | 05 | VT | MEDICAID |