Individual
KRISTAN M OUTWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21 BELMONT AVE, BRATTLEBORO, VT 05301-7110
(802) 258-3905
(802) 258-4903
Mailing address
600 BLAIR PARK RD STE 285, WILLISTON, VT 05495-7586
(802) 288-1140
(802) 288-1144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042-0012623
VT
2080P0203X
Pediatric Critical Care Medicine Physician
4301064412
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3067291
—
MI
01
—
71020000730099
BCBS OF MI
MI
Enumeration date
08/21/2006
Last updated
06/30/2023
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