Jane Helena Micciche, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1010015859 Issued in VT

Practice address

97 Sherman Dr
Suite 1
St Johnsbury, VT 05819-9280

Phone

(802) 748-5131

Fax

(802) 748-4237

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeastern Vermont Regional Hospital, Inc

  • Primary Care Clinic/Center
  • St Johnsbury, VT
  • NPI 1487732301
  NPD (past)
• Northeastern Vermont Regional Hospital, Inc.

  • Critical Access Hospital
  • St Johnsbury, VT
  • NPI 1326080268
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124138706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 TIMBER LN",
            "city": "FRANCONIA",
            "state": "NH",
            "postal_code": "035805021",
            "telephone_number": "603-823-8554",
            "fax_number": "603-823-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 SHERMAN DR",
            "address_2": "SUITE 1",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199280",
            "telephone_number": "802-748-5131",
            "fax_number": "802-748-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICCICHE",
        "first_name": "JANE",
        "middle_name": "HELENA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VT",
            "license": "1010015859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005217",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30008266",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marilyn McEnery
• Shannon McGrath, MS, OTR/L
• Lucille J McKee
• Frank J Meierdiercks, MD
• Richard Merrick, MD
• Peter G Miller, DDS
• Debra Ann Mills, QMHP
• Christine Milne-O'Grady, LICSW
• Milne-O'Grady, MSW LLC
• Gary H Mitchell, LADC

• Nurse Practitioner in St Johnsbury, VT
• Providers in St Johnsbury, VT by specialty
• Nurse Practitioner in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.