Provider Demographics
NPI:1336437029
Name:SPIESS, KATHRYN (CNM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SPIESS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-755-2344
Mailing Address - Fax:203-573-8166
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-755-2344
Practice Address - Fax:203-573-8166
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000356367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife