Healthcare Provider Details

I. General information

NPI: 1962485425
Provider Name (Legal Business Name): CAROL RUTH STAUGAARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS' BUILDING, 2ND FL
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

20 YORK ST YALE PHYSICIANS' BUILDING, 2ND FL
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4191
  • Fax: 203-737-3456
Mailing address:
  • Phone: 203-200-6622
  • Fax: 203-737-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number002736
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number002736
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: