Provider Demographics
NPI:1528059110
Name:RAGAISIS, KAREN M (APRN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:RAGAISIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5035
Mailing Address - Country:US
Mailing Address - Phone:860-972-9120
Mailing Address - Fax:
Practice Address - Street 1:80 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5035
Practice Address - Country:US
Practice Address - Phone:860-972-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000239163WP0808X, 363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004194148Medicaid
CT890000152Medicare ID - Type Unspecified
CT004194148Medicaid