Provider Demographics
NPI:1316996127
Name:WOHLBERG, JERI BRIAR (FNP)
Entity type:Individual
Prefix:MS
First Name:JERI
Middle Name:BRIAR
Last Name:WOHLBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:4 SLAPP HILL
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-0535
Practice Address - Country:US
Practice Address - Phone:802-472-3300
Practice Address - Fax:802-472-8277
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0025930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009991Medicaid
VTNP4288Medicare ID - Type Unspecified
VTQ24499Medicare UPIN