MEDICARE: MS. KATHERINE M. NICHOLS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	5939	CT

General Provider Information

NPI Number	:	1013956366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE M. NICHOLS APRN

Provider Business Mailing Address
First Line	:	75 SWANTOWN HL
Second Line	:	STONINGTON INSITUTE
City	:	NORTH STONINGTON
State	:	CT
Zip	:	06359-1022
Country	:	US
Telephone Number	:	860-535-1010
Fax Number	:	860-535-9076

Provider Business Practice Location Address
First Line	:	75 SWANTOWN HL
Second Line	:	STONINGTON INSTITUTE
City	:	NORTH STONINGTON
State	:	CT
Zip	:	06359-1022
Country	:	US
Telephone Number	:	860-535-1010
Fax Number	:	860-535-9076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	11/06/2014

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