Individual
ANNE THERESA VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1728 FORDHAM BLVD, 151 RAM'S PLAZA, CHAPEL HILL, NC 27514-2397
(919) 968-1985
(919) 942-0038
Mailing address
PO BOX 63362, 151 RAM'S PLAZA, CHARLOTTE, NC 28263-3362
(919) 620-4918
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100680
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100680
MEDICAL LICENSE
NC
Enumeration date
12/08/2006
Last updated
03/24/2016
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