Provider Demographics
NPI:1861404667
Name:MORNEAULT, MONIQUE M (PA-C)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:M
Last Name:MORNEAULT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:M
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:EAST PAVILION LEVEL 5
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4590
Mailing Address - Fax:802-847-3807
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:EAST PAVILION LEVEL 5
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4590
Practice Address - Fax:802-847-3807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000310Medicaid
VT9000310Medicaid
VTQ72554Medicare UPIN