Provider Demographics
NPI:1659344174
Name:THOMSEN, KATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:THOMSEN
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 1:44 DALE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4320
Mailing Address - Country:US
Mailing Address - Phone:860-674-8830
Mailing Address - Fax:860-674-8984
Practice Address - Street 1:30 JORDAN LN
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1278
Practice Address - Country:US
Practice Address - Phone:860-263-0253
Practice Address - Fax:860-263-0262
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3038363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23059Medicare UPIN
500001312Medicare ID - Type Unspecified