Provider Demographics
NPI:1427109578
Name:IMPEY, LORRAINE (APRN, BC, CGP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:IMPEY
Suffix:
Gender:F
Credentials:APRN, BC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8635
Practice Address - Country:US
Practice Address - Phone:802-748-3181
Practice Address - Fax:802-748-0704
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0008797363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0503Medicaid
VTNS2025Medicare ID - Type Unspecified