Healthcare Provider Details

I. General information

NPI: 1457752107
Provider Name (Legal Business Name): KRIPA PLAPETTA DAMODHARAN DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 CAMPBELL AVE STE F
WEST HAVEN CT
06516-3786
US

IV. Provider business mailing address

764 CAMPBELL AVE STE F
WEST HAVEN CT
06516-3786
US

V. Phone/Fax

Practice location:
  • Phone: 203-443-9500
  • Fax: 203-902-0509
Mailing address:
  • Phone: 203-443-9500
  • Fax: 203-902-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5910
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: