Provider Demographics
NPI:1497851281
Name:BUTKOVSKY, KIRSTEN (CRNA/APRN)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BUTKOVSKY
Suffix:
Gender:F
Credentials:CRNA/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7304
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-7304
Mailing Address - Country:US
Mailing Address - Phone:203-834-2847
Mailing Address - Fax:
Practice Address - Street 1:273 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5736
Practice Address - Country:US
Practice Address - Phone:603-526-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT070083367500000X
NH090511-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered