Provider Demographics
NPI:1487657276
Name:KACZEGOWICZ, NANCI E (APRN)
Entity type:Individual
Prefix:
First Name:NANCI
Middle Name:E
Last Name:KACZEGOWICZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1927
Mailing Address - Country:US
Mailing Address - Phone:203-374-9630
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE B-106
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-452-1411
Practice Address - Fax:203-452-1412
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004242442Medicaid
CTQ07139Medicare UPIN
CT500001213Medicare ID - Type Unspecified
CT004242442Medicaid