Healthcare Provider Details

I. General information

NPI: 1093620577
Provider Name (Legal Business Name): KATIE NICOLE WEISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL HILL RD
SHARON CT
06069-2092
US

IV. Provider business mailing address

67 CHRISTIAN ST
NEW PRESTON CT
06777-1803
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-4000
  • Fax:
Mailing address:
  • Phone: 860-921-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number203074
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: