Provider Demographics
NPI:1699914515
Name:VANDENBROEK, JARED J (CRNA)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:J
Last Name:VANDENBROEK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:PATIENT FINANCIAL SERVICES
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561
Mailing Address - Country:US
Mailing Address - Phone:603-259-7627
Mailing Address - Fax:603-259-7561
Practice Address - Street 1:600 ST. JOHNSBURY RD.
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561
Practice Address - Country:US
Practice Address - Phone:603-444-9000
Practice Address - Fax:419-423-5490
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067637-21367500000X
TNAPN13865367500000X
TNRN141595367500000X
NH067637-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered