Healthcare Provider Details

I. General information

NPI: 1598061939
Provider Name (Legal Business Name): CHRISTINE KAPHERR ELLIS M.S., R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 WATT POND RD
PUTNEY VT
05346-8962
US

IV. Provider business mailing address

73 WATT POND RD
PUTNEY VT
05346-8962
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-2164
  • Fax:
Mailing address:
  • Phone: 802-387-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number0740000048
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: