Basic Information
| Provider Information | |||||||||
| NPI: | 1639417397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UGUCCIONI | ||||||||
| FirstName: | KRYSTIN | ||||||||
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| Credential: | MS,APRN,WCN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 ALEWIFE RD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063853802 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 365 MONTAUK AVE | ||||||||
| Address2: | IPC HOSPITALISTS OF NEW ENGLAND | ||||||||
| City: | NEW LONDON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063204700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602714364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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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 | 363LA2100X | 3753 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.