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Individual

DR. KELLEY LARSON ETHERIDGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN/CRNA

Contact information

Practice address
195 EASTERN BLVD, GLASTONBURY, CT 06033-4312
(860) 667-9542
Mailing address
88 BLACK WALNUT DR, DURHAM, CT 06422-1400
(860) 575-2052

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
7675
CT

Other

Enumeration date
07/17/2018
Last updated
04/16/2025
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