Healthcare Provider Details

I. General information

NPI: 1205869112
Provider Name (Legal Business Name): KATHARINE NICOLE VARDANIAN MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROYCE CIR STE 104
STORRS CT
06268-2270
US

IV. Provider business mailing address

1 ROYCE CIR STE 104
STORRS CT
06268-2270
US

V. Phone/Fax

Practice location:
  • Phone: 860-487-9200
  • Fax: 860-487-9222
Mailing address:
  • Phone: 860-487-9200
  • Fax: 860-487-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number001111
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: