Provider Demographics
NPI:1033164819
Name:WERNER, KRISTEN (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 TILLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4484
Mailing Address - Country:US
Mailing Address - Phone:802-862-7338
Mailing Address - Fax:802-862-8411
Practice Address - Street 1:185 TILLEY DRIVWE
Practice Address - Street 2:
Practice Address - City:SO BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-7338
Practice Address - Fax:802-862-8411
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010020073367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009627Medicaid
VTS50118OtherUPIN
VTS50118OtherUPIN