Healthcare Provider Details

I. General information

NPI: 1134589575
Provider Name (Legal Business Name): KATIE L HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MAIN ST
MONTPELIER VT
05602-2702
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-4738
  • Fax: 802-223-4616
Mailing address:
  • Phone: 802-223-4738
  • Fax: 802-223-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0118772
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: