Provider Demographics
NPI:1013942465
Name:KLINE, NANCY LOU (ANP/APRN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOU
Last Name:KLINE
Suffix:
Gender:F
Credentials:ANP/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WOODSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-397-3535
Mailing Address - Fax:
Practice Address - Street 1:133 SCOVILL STREET-WATERBURY VA COMMUNITY BASED CLINIC
Practice Address - Street 2:#203
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706
Practice Address - Country:US
Practice Address - Phone:203-465-5292
Practice Address - Fax:203-465-5296
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000755363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health