Provider Demographics
NPI:1093783821
Name:BULLETTSMITH, AIMEE (NP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:BULLETTSMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:802-442-2997
Mailing Address - Fax:802-447-0635
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 215
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-442-2997
Practice Address - Fax:802-447-0635
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0023089363L00000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008064Medicaid
VTUX9151Medicare PIN
VTP35849Medicare UPIN