Provider Demographics
NPI:1710978275
Name:NYSTROM, KARIN VERNA (APRN)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:VERNA
Last Name:NYSTROM
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:40 TEMPLE ST
Mailing Address - Street 2:SUITE 6-C
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2715
Mailing Address - Country:US
Mailing Address - Phone:203-785-4085
Mailing Address - Fax:203-737-1597
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 6-C
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-4085
Practice Address - Fax:203-737-1597
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-03-17
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Provider Licenses
StateLicense IDTaxonomies
CT002154364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist