Healthcare Provider Details

I. General information

NPI: 1528059110
Provider Name (Legal Business Name): KAREN M RAGAISIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN M MUELLER

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JEFFERSON ST
HARTFORD CT
06106-5035
US

IV. Provider business mailing address

80 JEFFERSON ST
HARTFORD CT
06106-5035
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-9120
  • Fax:
Mailing address:
  • Phone: 860-972-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number000239
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000239
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number000239
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: