Individual
KATHRYN E JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
455 LEWIS AVE, SUITE 106, MERIDEN, CT 06451-2121
(203) 886-0036
(203) 886-0072
Mailing address
2139 SILAS DEANE HWY, ROCKY HILL, CT 06067-2336
(860) 257-4131
(860) 257-4519
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
002455
CT
363LA2200X
Adult Health Nurse Practitioner
Primary
002455
CT
363LF0000X
Family Nurse Practitioner
002455
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004219491
—
CT
Enumeration date
07/26/2006
Last updated
11/05/2013
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