Provider Demographics
NPI:1104809185
Name:KASTNER, NANCY CHAPMAN (BS)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CHAPMAN
Last Name:KASTNER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:LYNDA
Other - Last Name:DUTKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1 WAHOO AVE BLDG 449
Mailing Address - Street 2:NAVAL AMBULATORY CARE CENTER ATTN: PROF. AFFAIRS
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2324
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:1 WAHOO AVE BLDG 449
Practice Address - Street 2:NAVAL AMBULATORY CARE CENTER ATTN: PROF. AFFAIRS
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2324
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-2590
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54521835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN