Healthcare Provider Details

I. General information

NPI: 1710978275
Provider Name (Legal Business Name): KARIN VERNA NYSTROM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TEMPLE ST SUITE 6-C
NEW HAVEN CT
06510-2715
US

IV. Provider business mailing address

40 TEMPLE ST SUITE 6-C
NEW HAVEN CT
06510-2715
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4085
  • Fax: 203-737-1597
Mailing address:
  • Phone: 203-785-4085
  • Fax: 203-737-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number002154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: