Healthcare Provider Details

I. General information

NPI: 1417472291
Provider Name (Legal Business Name): AMY CATHERINE PAWLAK DNP, CRNA, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

5 MOHAWK LN
WOODBRIDGE CT
06525-1401
US

V. Phone/Fax

Practice location:
  • Phone: 203-376-6271
  • Fax:
Mailing address:
  • Phone: 203-376-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number063172-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7163
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: