Provider Demographics
NPI:1174548960
Name:HOSTERMAN, CATHERINE A (APRN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:A
Last Name:HOSTERMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-4206
Mailing Address - Country:US
Mailing Address - Phone:860-672-0105
Mailing Address - Fax:
Practice Address - Street 1:11 INTERLAKEN RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:CT
Practice Address - Zip Code:06039
Practice Address - Country:US
Practice Address - Phone:860-435-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002560OtherAPRN
CTE60405OtherRN LICENSE
06-1088532OtherTAX ID #
CT5217495Medicaid
CT31374OtherCT CONTROLLED SUBSTANCE
CT31374OtherCT CONTROLLED SUBSTANCE
CT5217495Medicaid
CT002560OtherAPRN
C00633Medicare ID - Type UnspecifiedMR GROUP #