Healthcare Provider Details

I. General information

NPI: 1477527224
Provider Name (Legal Business Name): KAREN R PARKHURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GRANDVIEW AVE SUITE #101
WATERBURY CT
06708-2505
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE #201
MIDDLEBURY CT
06762-1805
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-7284
  • Fax: 203-573-7031
Mailing address:
  • Phone: 203-573-9512
  • Fax: 203-568-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE54317
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000825
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: