Basic Information
Provider Information | |||||||||
NPI: | 1235525940 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAINA | ||||||||
FirstName: | CATHERINE | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAWRENCE | ||||||||
OtherFirstName: | CATHERINE | ||||||||
OtherMiddleName: | W | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1150 | ||||||||
Address2: | C/O UVMHN E ELKINS | ||||||||
City: | BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054021150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028471882 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3 TIMBER LANE | ||||||||
Address2: | UVMHN TIMBER LANE FAMILY PRACTICE | ||||||||
City: | SOUTH BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 05403 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028478500 | ||||||||
FaxNumber: | 8023343512 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/09/2015 | ||||||||
LastUpdateDate: | 01/13/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/13/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 101-0109814 | VT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.