Provider Demographics
NPI:1790729564
Name:CHUTTER-CRESSY, BRUCE ALAN (PA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:CHUTTER-CRESSY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:ALAN
Other - Last Name:CRESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 STONE WALL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9325
Mailing Address - Country:US
Mailing Address - Phone:802-425-2981
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant