Provider Demographics
NPI:1619259611
Name:KWASSMAN, DEVON MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:MICHELLE
Last Name:KWASSMAN
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 1:75 AVONWOOD RD APT A16
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2089
Mailing Address - Country:US
Mailing Address - Phone:860-550-3791
Mailing Address - Fax:
Practice Address - Street 1:469 MIGEON AVE
Practice Address - Street 2:COMMUNITY HEALTH & WELLNESS CTR. OF GREATER TORRINGTON
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4643
Practice Address - Country:US
Practice Address - Phone:860-489-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4804363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247872Medicaid