Provider Demographics
NPI:1962485425
Name:STAUGAARD, CAROL RUTH (APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RUTH
Last Name:STAUGAARD
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YALE PHYSICIANS' BUILDING, 2ND FL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-200-6622
Mailing Address - Fax:203-737-2424
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:YALE PHYSICIANS' BUILDING, 2ND FL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-688-4191
Practice Address - Fax:203-737-3456
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-10-17
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Provider Licenses
StateLicense IDTaxonomies
CT002736363LA2200X, 364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004229094Medicaid
CT500001019Medicare ID - Type Unspecified
P83163Medicare UPIN