MEDICARE: NANCI E KACZEGOWICZ 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	363LF0000X	Family Nurse Practitioner	002926	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487657276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCI E KACZEGOWICZ APRN

Provider Business Mailing Address
First Line	:	44 MARSH RD
Second Line	:
City	:	EASTON
State	:	CT
Zip	:	06612-1927
Country	:	US
Telephone Number	:	203-374-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 TECHNOLOGY DR
Second Line	:	SUITE B-106
City	:	TRUMBULL
State	:	CT
Zip	:	06611-6337
Country	:	US
Telephone Number	:	203-452-1411
Fax Number	:	203-452-1412

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/26/2011

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