Healthcare Provider Details

I. General information

NPI: 1982945036
Provider Name (Legal Business Name): ADRIENNE VOUTILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE BONVINI PA-C

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PARK AVE
WILLISTON VT
05495-9701
US

IV. Provider business mailing address

80 FAIRFIELD ST
SAINT ALBANS VT
05478-1728
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-1008
  • Fax:
Mailing address:
  • Phone: 802-878-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4573
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031233
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: