Individual
AGNES MIKIJANIEC
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
17 BELMONT AVE, ATT'N: MARILYN BOUDREAU, BRATTLEBORO, VT 05301-6613
(802) 257-8382
(802) 251-8466
Mailing address
17 BELMONT AVE, ATT'N: MARILYN BOUDREAU, BRATTLEBORO, VT 05301-6613
(802) 257-8382
(802) 251-8466
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
026-0029155
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68614
BLUE SHIELD OF VT
VT
05
—
ONP3598
—
VT
Enumeration date
06/25/2006
Last updated
07/08/2007
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