Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 101.0134384 | VT |
NPI | 1194379669 |
---|---|
Provider Name | Nicole Marie Cloutier |
First Address | Colchester, VT 05401 |
Second Address | Burlington, VT 05401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 11/08/2019 |