Provider Demographics
NPI:1285067074
Name:MASOUD, KATHERINE M (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:MASOUD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-371-7048
Mailing Address - Fax:203-371-7066
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-371-7048
Practice Address - Fax:203-371-7066
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily