Healthcare Provider Details

I. General information

NPI: 1316985831
Provider Name (Legal Business Name): ANA BURTNETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA HAUSER-BURNETT

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 PAINE MOUNTAIN DR
NORTHFIELD VT
05663-5791
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-4161
  • Fax:
Mailing address:
  • Phone: 802-485-4161
  • Fax: 802-485-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number055-0031200
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number351
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031200
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: