MEDICARE: MS. KATHLEEN M NISHIDA CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN355082L	PA
2	176B00000X	Midwife	600	CT
3	176B00000X	Midwife	MW008566L	PA
4	163W00000X	Registered Nurse	E59418	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003913823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN M NISHIDA CNM

Provider Business Mailing Address
First Line	:	46 ALBION ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-2602
Country	:	US
Telephone Number	:	203-330-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 PARK AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-5859
Country	:	US
Telephone Number	:	203-330-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/26/2026

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