Healthcare Provider Details

I. General information

NPI: 1013956366
Provider Name (Legal Business Name): KATHERINE M. NICHOLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SWANTOWN HL STONINGTON INSTITUTE
NORTH STONINGTON CT
06359-1022
US

IV. Provider business mailing address

75 SWANTOWN HL STONINGTON INSITUTE
NORTH STONINGTON CT
06359-1022
US

V. Phone/Fax

Practice location:
  • Phone: 860-535-1010
  • Fax: 860-535-9076
Mailing address:
  • Phone: 860-535-1010
  • Fax: 860-535-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number5939
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: