Basic Information
| Provider Information | |||||||||
| NPI: | 1871149153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KREVOLIN | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 WHITNEY AVE STE 360 | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032814463 | ||||||||
| FaxNumber: | 2032872930 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 WHITNEY AVE STE 360 | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032814463 | ||||||||
| FaxNumber: | 2032872930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2019 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8472 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.