Healthcare Provider Details

I. General information

NPI: 1881314839
Provider Name (Legal Business Name): HAILEY MARIE BONNEAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY MARIE NADEA

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 ELM ST
BARTON VT
05822-8637
US

IV. Provider business mailing address

488 ELM ST
BARTON VT
05822-8637
US

V. Phone/Fax

Practice location:
  • Phone: 802-525-3539
  • Fax:
Mailing address:
  • Phone: 802-525-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135672PROV
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: