MEDICARE: ANNE L VAILLANT PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	206006	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	206006	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033114632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE L VAILLANT PMHNP-BC

Provider Business Mailing Address
First Line	:	17 RESEARCH DRIVE
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002
Country	:	US
Telephone Number	:	413-549-8400
Fax Number	:	413-549-8409

Provider Business Practice Location Address
First Line	:	17 RESEARCH DRIVE
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002
Country	:	US
Telephone Number	:	413-549-8400
Fax Number	:	413-549-8409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	01/28/2022

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