Healthcare Provider Details

I. General information

NPI: 1093000648
Provider Name (Legal Business Name): KATHLEEN ANNE GUILMAIN APRN GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 COUNTRY LAND DR
NORTH HAVERHILL NH
03774-5812
US

IV. Provider business mailing address

3086 GLOVER ST
GLOVER VT
05839-9701
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-4161
  • Fax:
Mailing address:
  • Phone: 802-525-6600
  • Fax: 802-525-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number101.0134284
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number056501-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: