Provider Demographics
NPI:1831217843
Name:BIENVENU, AMY CHRISTINE (LMP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CHRISTINE
Last Name:BIENVENU
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 RICHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:VT
Mailing Address - Zip Code:05778-9501
Mailing Address - Country:US
Mailing Address - Phone:360-472-1356
Mailing Address - Fax:
Practice Address - Street 1:99 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1595
Practice Address - Country:US
Practice Address - Phone:360-472-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist