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General NPI Number Information
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NPI Number | 1942608914
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Entity Type | Individual
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Provider Name | KATHRYN PETERSON RN
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 105 WINTER ST APT 2
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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 | 802-579-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WINTER ST # 2
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6667
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Country | US
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Telephone |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 025.0105165
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 026.0135444
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License Number State | VT
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