MEDICARE: KATHRYN ELIZABETH SAMUELSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	026.0095543	VT

General Provider Information

NPI Number	:	1053033621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ELIZABETH SAMUELSON RN

Provider Business Mailing Address
First Line	:	431 E ARLINGTON RD APT A
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-9124
Country	:	US
Telephone Number	:	802-430-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1073 E ARLINGTON RD
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-8497
Country	:	US
Telephone Number	:	802-430-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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