MEDICARE: KATHIANA PRINCY APRN

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	15409	CT
2	163W00000X	Registered Nurse	171090	CT
3	363L00000X	Nurse Practitioner	15409	CT

General Provider Information

NPI Number	:	1588370316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHIANA PRINCY APRN

Provider Business Mailing Address
First Line	:	60 WESTWOOD AVE STE 200
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-2460
Country	:	US
Telephone Number	:	203-574-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 WESTWOOD AVE STE 200
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-2460
Country	:	US
Telephone Number	:	203-574-5501
Fax Number	:

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

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/08/2026

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