Basic Information
| Provider Information | |||||||||
| NPI: | 1346659778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIERNOZEK | ||||||||
| FirstName: | CATHY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 WINDING RDG | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064892180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608390781 | ||||||||
| FaxNumber: | 8552322539 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CAPITAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060673576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602210549 | ||||||||
| FaxNumber: | 8552478787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2014 | ||||||||
| LastUpdateDate: | 11/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 5818 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | 5818 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.