Provider Demographics
NPI:1790282630
Name:FREETO, KRISTIN SHAE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SHAE
Last Name:FREETO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-9244
Mailing Address - Country:US
Mailing Address - Phone:802-626-5432
Mailing Address - Fax:
Practice Address - Street 1:339 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-9244
Practice Address - Country:US
Practice Address - Phone:802-626-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH072264-21163W00000X
VT026.0087051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse