Individual
ANTONIETTA E VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
AMD-789
HI
363AS0400X
Surgical Physician Assistant
Primary
C06707
MD
Other
Enumeration date
12/26/2017
Last updated
02/20/2024
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