Provider Demographics
NPI:1083611297
Name:CUSANO, KAREN J (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:CUSANO
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 1:269 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1403
Mailing Address - Country:US
Mailing Address - Phone:860-228-9463
Mailing Address - Fax:860-228-3766
Practice Address - Street 1:269 CHURCH ST
Practice Address - Street 2:
Practice Address - City:AMSTON
Practice Address - State:CT
Practice Address - Zip Code:06231-1403
Practice Address - Country:US
Practice Address - Phone:860-228-9463
Practice Address - Fax:860-228-3766
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V1323OtherHEALTH NET
163400OtherCT CARE
400001634CT02OtherBCBS
P2985559OtherOXFORD
400001634CT02OtherBCBS