Provider Demographics
NPI:1558489161
Name:CARIUS, KATHLEEN PATRICIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:CARIUS
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 1:340 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5412
Mailing Address - Country:US
Mailing Address - Phone:203-367-5589
Mailing Address - Fax:203-330-0830
Practice Address - Street 1:340 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5412
Practice Address - Country:US
Practice Address - Phone:203-367-5589
Practice Address - Fax:203-330-0830
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR35259163W00000X
CT003880363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid