Basic Information
| Provider Information | |||||||||
| NPI: | 1568606416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERTZ | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | JENNIFER | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 COMMERCE ST | ||||||||
| Address2: | FAHC/HINESBURG FAMILY HEALTH | ||||||||
| City: | HINESBURG | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054619303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028477000 | ||||||||
| FaxNumber: | 8028475238 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 COMMERCE ST | ||||||||
| Address2: | FAHC - HINESBURG FAMILY MEDICINE | ||||||||
| City: | HINESBURG | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054619303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028477000 | ||||||||
| FaxNumber: | 8028475238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A109764 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0420012791 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.