Provider Demographics
NPI:1245738269
Name:CAVANAUGH, PATRICIA (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PARKER PL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3958
Mailing Address - Country:US
Mailing Address - Phone:630-361-5676
Mailing Address - Fax:
Practice Address - Street 1:491 GOLD STAR HWY STE 100
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6226
Practice Address - Country:US
Practice Address - Phone:860-445-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN58001163W00000X
CT7874363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse