Healthcare Provider Details

I. General information

NPI: 1831885169
Provider Name (Legal Business Name): KRISTINE NOELLE PAVLOVIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE NOELLE HATCHER RN

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 10/12/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 N MAIN ST UNIT 101
CAMBRIDGE VT
05444
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-5114
  • Fax: 802-888-6075
Mailing address:
  • Phone: 802-851-8619
  • Fax: 802-851-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0136022
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101.0136022
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: