Healthcare Provider Details

I. General information

NPI: 1669810420
Provider Name (Legal Business Name): KATHYRN J HARRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 GREEN MOUNTAIN TNPK
CHESTER VT
05143
US

IV. Provider business mailing address

1712 GREEN MOUNTAIN TNPK
CHESTER VT
05143
US

V. Phone/Fax

Practice location:
  • Phone: 802-875-5683
  • Fax: 802-875-6455
Mailing address:
  • Phone: 802-875-5683
  • Fax: 802-875-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0260013099
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: