Healthcare Provider Details

I. General information

NPI: 1982114914
Provider Name (Legal Business Name): JOAN ELIZABETH KUCIENSKI AG-NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 03/24/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST BLDG 502
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberE47785
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberRN179304
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN179304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: