Provider Demographics
NPI:1447625785
Name:DINSMORE, KEVIN (APRN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DINSMORE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 CHAPEL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4411
Mailing Address - Country:US
Mailing Address - Phone:203-624-4400
Mailing Address - Fax:203-624-4402
Practice Address - Street 1:1423 CHAPEL ST STE 1A
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4411
Practice Address - Country:US
Practice Address - Phone:203-624-4400
Practice Address - Fax:203-624-4402
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT90885163W00000X
CT12.006412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse