MEDICARE: MRS. KATHLEEN ANNE GUILMAIN APRN GNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	101.0134284	VT
2	363LG0600X	Gerontology Nurse Practitioner	056501-23	NH

General Provider Information

NPI Number	:	1093000648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN ANNE GUILMAIN APRN GNP-BC

Provider Business Mailing Address
First Line	:	3086 GLOVER ST
Second Line	:
City	:	GLOVER
State	:	VT
Zip	:	05839-9701
Country	:	US
Telephone Number	:	802-525-6600
Fax Number	:	802-525-6952

Provider Business Practice Location Address
First Line	:	299 COUNTRY LAND DR
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-5812
Country	:	US
Telephone Number	:	603-747-4161
Fax Number	:

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

Provider Enumeration Date	:	06/12/2011
Last Update Date	:	08/31/2019

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