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General NPI Number Information
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NPI Number | 1679170922
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Entity Type | Individual
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Provider Name | KATRINA MARIE PRIVE MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 1 ANNA MARSH LANE
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City | BRATTLEBORO
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State | VT
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Zip | 05301
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Country | US
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Telephone | 802-738-7328
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1153
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City | DERBY
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State | VT
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Zip | 05829-5153
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Country | US
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Telephone | 802-323-3152
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0134670
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License Number State | VT
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