Healthcare Provider Details

I. General information

NPI: 1194759837
Provider Name (Legal Business Name): KAREN ANN HAMMOND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CHASE PARKWAY SUITE B
WATERBURY CT
06708
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-6311
  • Fax: 203-755-6263
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002398
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002398
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: