Provider Demographics
NPI:1568265494
Name:HERLES, KATLYN GAIL
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:GAIL
Last Name:HERLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2615
Mailing Address - Country:US
Mailing Address - Phone:845-242-0207
Mailing Address - Fax:
Practice Address - Street 1:145 MEADOW ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2615
Practice Address - Country:US
Practice Address - Phone:845-242-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse