Provider Demographics
NPI:1790159614
Name:BALESTRIERE, KAITLIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BALESTRIERE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:KOWALSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:191 LAURELBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1916
Mailing Address - Country:US
Mailing Address - Phone:203-453-3844
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered