Healthcare Provider Details

I. General information

NPI: 1245265404
Provider Name (Legal Business Name): KATHLEEN E WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARK ST
SPRINGFIELD VT
05156-3032
US

IV. Provider business mailing address

27 GREENHILL PKWY
BRATTLEBORO VT
05301-6255
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-4701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1010013425
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: