Provider Demographics
NPI:1982878625
Name:TUMMILLO, KATHLEEN WARD (MS APRN ANP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:WARD
Last Name:TUMMILLO
Suffix:
Gender:F
Credentials:MS APRN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODLAND ST
Mailing Address - Street 2:AMBULATORY ADMINISTRATION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1208
Mailing Address - Country:US
Mailing Address - Phone:860-714-9900
Mailing Address - Fax:860-714-7521
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:AMBULATORY ADMINISTRATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-9900
Practice Address - Fax:860-714-7521
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000933363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health