Provider Demographics
NPI:1275202087
Name:EAGLE, KATHLEEN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:EAGLE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 THREE CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2531
Mailing Address - Country:US
Mailing Address - Phone:860-798-5040
Mailing Address - Fax:
Practice Address - Street 1:620 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2156
Practice Address - Country:US
Practice Address - Phone:860-892-8012
Practice Address - Fax:860-892-8027
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily