Provider Demographics
NPI:1316985831
Name:BURTNETT, ANA (PA-C)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BURTNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:HAUSER-BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-485-4161
Mailing Address - Fax:802-485-4163
Practice Address - Street 1:87 PAINE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5791
Practice Address - Country:US
Practice Address - Phone:802-485-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031200207Q00000X
NH351363A00000X
VT055.0031200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY400131127OtherMEDICARE PTAN LINKED TO CVMC MGP
NHP03127Medicare UPIN