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Get Mid Level Providers Form

Practitioners (NP), Physician Assistants (PA), Certified Nurse Anesthetists (CRNA), Certified Nurse Midwives (CNM), Advanced Practice Register Nurse (APRN), and Anesthesia Assistants (AA) (VT only). On the back page is the registration form. Please keep in mind the following information when completing the form: a.) This form is for only midlevel practitioners who have never been registered before. If you are a midlevel and you need to change previously submitted information, please submit the.

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