Healthcare Provider Details

I. General information

NPI: 1952156556
Provider Name (Legal Business Name): KAREN ENNIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GEORGE ST APT 1B
NEW HAVEN CT
06511-5361
US

IV. Provider business mailing address

2335 DIXWELL AVE STE 2
HAMDEN CT
06514-2100
US

V. Phone/Fax

Practice location:
  • Phone: 203-350-9530
  • Fax: 802-541-3801
Mailing address:
  • Phone: 203-350-9530
  • Fax: 802-541-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13302
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162109
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: