MEDICARE: MS. KATHLEEN REO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	101-0020997	VT

General Provider Information

NPI Number	:	1912117847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN REO FNP

Provider Business Mailing Address
First Line	:	276 STONE WALL LN
Second Line	:
City	:	CHARLOTTE
State	:	VT
Zip	:	05445-9329
Country	:	US
Telephone Number	:	802-425-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MARSETT RD STE 2
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6640
Country	:	US
Telephone Number	:	802-985-5099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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