Healthcare Provider Details

I. General information

NPI: 1598227514
Provider Name (Legal Business Name): KATHRYN JANET DEWAR CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PARK ST STE 3C
MIDDLEBURY VT
05753-1169
US

IV. Provider business mailing address

18 N BINGHAM ST
CORNWALL VT
05753-8676
US

V. Phone/Fax

Practice location:
  • Phone: 503-961-4132
  • Fax:
Mailing address:
  • Phone: 207-491-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number107.0129904
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: