Provider Demographics
NPI:1003199217
Name:BAJDA, KATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BAJDA
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 1:837 PROSPECT DRIVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615
Mailing Address - Country:US
Mailing Address - Phone:203-521-6905
Mailing Address - Fax:
Practice Address - Street 1:837 PROSPECT DRIVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-521-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4768363L00000X
CT4798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner