Provider Demographics
NPI:1306978523
Name:MONTGOMERY, ANNE CLOUTIER (PA)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:CLOUTIER
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:21 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7110
Mailing Address - Country:US
Mailing Address - Phone:802-257-2611
Mailing Address - Fax:802-257-2655
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-257-2611
Practice Address - Fax:802-257-2655
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT55-0030154363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical