Basic Information
| Provider Information | |||||||||
| NPI: | 1912301193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASMUS | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 EXCHANGE ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057534464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028552027 | ||||||||
| FaxNumber: | 8028552053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 EXCHANGE ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057534464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028552027 | ||||||||
| FaxNumber: | 8028552053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2014 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0101390 | VT | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 101-0107739 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1024132 | 05 | VT | MEDICAID | 04088579 | 05 | NY | MEDICAID |