Basic Information
| Provider Information | |||||||||
| NPI: | 1710978275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NYSTROM | ||||||||
| FirstName: | KARIN | ||||||||
| MiddleName: | VERNA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 TEMPLE ST | ||||||||
| Address2: | SUITE 6-C | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065102715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854085 | ||||||||
| FaxNumber: | 2037371597 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 TEMPLE ST | ||||||||
| Address2: | SUITE 6-C | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065102715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854085 | ||||||||
| FaxNumber: | 2037371597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | 002154 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.