Provider Demographics
NPI:1922698315
Name:SPERRY, CATHERINE STILLMAN (MSN RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:STILLMAN
Last Name:SPERRY
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80A HERITAGE VLG # A
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1660
Mailing Address - Country:US
Mailing Address - Phone:203-833-1565
Mailing Address - Fax:
Practice Address - Street 1:80A HERITAGE VLG # A
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1660
Practice Address - Country:US
Practice Address - Phone:203-833-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77738163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT77738OtherNURSING
CT77738OtherGENERAL PRACTICE