Provider Demographics
NPI:1528191608
Name:KELLIHER, LAUREL H (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:H
Last Name:KELLIHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-660-9438
Practice Address - Street 1:11 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3205
Practice Address - Country:US
Practice Address - Phone:866-476-1321
Practice Address - Fax:802-660-9437
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010021166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP1729Medicaid
VTS76887Medicare UPIN