Healthcare Provider Details

I. General information

NPI: 1689329567
Provider Name (Legal Business Name): KATHERINE NUNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE FOLEY

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8040
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2100
  • Fax: 860-679-4815
Mailing address:
  • Phone: 860-679-2100
  • Fax: 860-676-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5690
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: