Provider Demographics
NPI:1457470148
Name:KATAKA, SUSANA WAYETA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:WAYETA
Last Name:KATAKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:WAYETA
Other - Last Name:KATAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC, MSN
Mailing Address - Street 1:575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2845
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:
Practice Address - Street 1:85 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1803
Practice Address - Country:US
Practice Address - Phone:860-224-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680495207V00000X, 363LW0102X
TXAP113842363LW0102X
CT11938363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology