Doctor Name: | JESSE DYLAN CHLEBECK |
NPI Number: | 1073879185 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 95 Carrigan Dr 436 Stafford Hall Burlington, VT - 054051746 |
Business Phone Number: | 8028472700 |
Business Fax Number: | 8026564247 |
Mailing Address: | 1438 Camel Back Ln, Apt 206 BOISE |
State: | ID |
Postal Code: | 837026577 |
Phone Number: | 6514910704 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2012 |
NPI Last Update Date: | 04/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |