Basic Information
| Provider Information | |||||||||
| NPI: | 1588672331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CZAPLICKI | ||||||||
| OtherFirstName: | CARRIE | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 ROSE LANE | ||||||||
| Address2: | |||||||||
| City: | NORTH BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034839124 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7365 MAIN ST STE 310 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066141300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843174 | ||||||||
| FaxNumber: | 2033844619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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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 | 367500000X | APRN003213 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.