Provider Demographics
NPI:1285714832
Name:VANDALL, JEFFREY MATTHEW (DNP, APRN,CRNA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:VANDALL
Suffix:
Gender:M
Credentials:DNP, APRN,CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 EXETER FARMS RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4885
Mailing Address - Country:US
Mailing Address - Phone:978-606-3719
Mailing Address - Fax:
Practice Address - Street 1:26 EXETER FARMS RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4885
Practice Address - Country:US
Practice Address - Phone:978-606-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH051248-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered