Healthcare Provider Details

I. General information

NPI: 1942563283
Provider Name (Legal Business Name): KATHRYN H BURNELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN H DAVIS

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CEDAR LANE
DANVILLE VT
05828-0185
US

IV. Provider business mailing address

165 SHERMAN DR
ST JOHNSBURY VT
05819-9811
US

V. Phone/Fax

Practice location:
  • Phone: 802-684-2275
  • Fax: 802-684-3839
Mailing address:
  • Phone: 802-748-9405
  • Fax: 802-748-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1010087049
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: