Provider Demographics
NPI:1447228697
Name:KACK, KARITA E (CRNA, MS, APRN)
Entity Type:Individual
Prefix:
First Name:KARITA
Middle Name:E
Last Name:KACK
Suffix:
Gender:F
Credentials:CRNA, MS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B4 SAINT MARC CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-4131
Mailing Address - Country:US
Mailing Address - Phone:860-528-2882
Mailing Address - Fax:
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-649-1550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002196367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered