Healthcare Provider Details

I. General information

NPI: 1912117847
Provider Name (Legal Business Name): KATHLEEN REO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARSETT RD STE 2
SHELBURNE VT
05482-6640
US

IV. Provider business mailing address

276 STONE WALL LN
CHARLOTTE VT
05445-9329
US

V. Phone/Fax

Practice location:
  • Phone: 802-985-5099
  • Fax:
Mailing address:
  • Phone: 802-425-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0020997
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: