Individual
VICKIEMARIE CLOUTIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 E GREEN BAY ST, SHAWANO, WI 54166-2210
(715) 201-0870
Mailing address
1300 E GREEN BAY ST, SHAWANO, WI 54166-2210
(715) 201-0870
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44889-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34558300
EDS
—
05
—
34558300
—
WI
01
—
450030594
MEDICARE PTAN
WI
01
—
700C610000
BCBS
—
Enumeration date
06/15/2005
Last updated
04/29/2026
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