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General NPI Number Information
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NPI Number | 1295873545
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Entity Type | Individual
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Provider Name | KATHERINE MITCHELL HOUGH ADULT NURSE PRACTITI
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 322 STATE RD FAMILY PLANNING OF MARDTAS VINEYARD
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City | VINEYARD HAVEN
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State | MA
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Zip | 02568
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Country | US
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Telephone | 508-693-1208
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Fax | 508-693-1299
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Provider Business Mailing Address
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Address Line | PO BOX 281
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City | WEST TISBURY
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State | MA
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Zip | 02575
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Country | US
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Telephone | 508-693-2376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN87001
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License Number State | MA
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