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General NPI Number Information
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NPI Number | 1932295656
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Entity Type | Individual
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Provider Name | CATHERINE G MICINILIO APRN
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 7003 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614
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Country | US
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Telephone | 203-257-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 30 INVERNESS RD
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City | TRUMBULL
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State | CT
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Zip | 06611-1716
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Country | US
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Telephone | 203-257-6647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 001098
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 001098
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License Number State | CT
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