Healthcare Provider Details

I. General information

NPI: 1942407069
Provider Name (Legal Business Name): KIMBERLY L VETAL F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E OLD STURBRIDGE RD
BRIMFIELD MA
01010-9647
US

IV. Provider business mailing address

255 E OLD STURBRIDGE RD
BRIMFIELD MA
01010-9647
US

V. Phone/Fax

Practice location:
  • Phone: 413-245-3389
  • Fax: 413-245-4553
Mailing address:
  • Phone: 413-245-0966
  • Fax: 413-245-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number195415
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: