Individual
KETTLY CASSAMAJOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4920 MAIN ST STE 302, BRIDGEPORT, CT 06606-1300
(475) 210-4960
(203) 371-0542
Mailing address
1290 SILAS DEANE HWY, HARTFORD HEALTHCARE-CVO, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12.006973
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004234788
—
CT
Enumeration date
03/22/2017
Last updated
03/09/2023
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