Individual
STEPHANIE KACIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 200-4363
Mailing address
20 YORK ST, NEW HAVEN, CT 06510-3220
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5954
CT
363LG0600X
Gerontology Nurse Practitioner
5954
CT
Other
Enumeration date
10/14/2014
Last updated
11/07/2014
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