Healthcare Provider Details

I. General information

NPI: 1679170922
Provider Name (Legal Business Name): KATRINA MARIE PRIVE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 01/29/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNA MARSH LANE
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

PO BOX 1153
DERBY VT
05829-5153
US

V. Phone/Fax

Practice location:
  • Phone: 802-738-7328
  • Fax:
Mailing address:
  • Phone: 802-323-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134670
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: