Healthcare Provider Details

I. General information

NPI: 1588088355
Provider Name (Legal Business Name): MS. KATHRYN CREAGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HOSPITAL PLAZA SUITE 502
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

215 STILLWATER AVE STE B
STAMFORD CT
06902-9504
US

V. Phone/Fax

Practice location:
  • Phone: 203-348-7410
  • Fax: 203-961-8488
Mailing address:
  • Phone: 203-348-7410
  • Fax: 203-961-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5727
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: