Provider Demographics
NPI:1598061939
Name:ELLIS, CHRISTINE KAPHERR (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KAPHERR
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 WATT POND RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8962
Mailing Address - Country:US
Mailing Address - Phone:802-387-2164
Mailing Address - Fax:
Practice Address - Street 1:73 WATT POND RD
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8962
Practice Address - Country:US
Practice Address - Phone:802-387-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740000048133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric