Basic Information
| Provider Information | |||||||||
| NPI: | 1235893728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KITA | ||||||||
| FirstName: | HANA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SWANTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054881447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028683175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SWANTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054881447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028683175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | 1010135206 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.