Provider Demographics
NPI:1558609677
Name:HETRICK, KAREN E (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:HETRICK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:E
Other - Last Name:HETRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-0265
Mailing Address - Country:US
Mailing Address - Phone:802-698-8318
Mailing Address - Fax:
Practice Address - Street 1:2574 CHRISTIAN ST APT 4
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-5404
Practice Address - Country:US
Practice Address - Phone:802-698-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0069771175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay