Provider Demographics
NPI:1093718876
Name:KAMLANI, ELIZABETH T (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:KAMLANI
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 1:575 WINNEPOGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2562
Mailing Address - Country:US
Mailing Address - Phone:203-763-9452
Mailing Address - Fax:
Practice Address - Street 1:575 WINNEPOGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2562
Practice Address - Country:US
Practice Address - Phone:203-763-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003040363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247799Medicaid
CT004247799Medicaid
CTQ37350Medicare UPIN