Individual
AMBERLEY NOEL MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LATC
Contact information
Practice address
458 VT ROUTE 100, HARWOOD UNION HIGH SCHOOL, SOUTH DUXBURY, VT 05660-9128
(802) 882-1121
(802) 882-1198
Mailing address
458 VT ROUTE 100, HARWOOD UNION HIGH SCHOOL, SOUTH DUXBURY, VT 05660-9128
(802) 882-1121
(802) 882-1198
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
104-0000130
VT
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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