| Doctor Name: | KATHLEEN A ENNIS |
| NPI Number: | 1750417358 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, DNPC |
| License Number: | 001317 |
| Business Practice Address: | 30 Orchard St Cos Cob, CT - 068072403 |
| Business Phone Number: | 2032532225 |
| Business Fax Number: | 2038694421 |
| Mailing Address: | 30 Orchard St, COS COB |
| State: | CT |
| Postal Code: | 068072403 |
| Phone Number: | 2032532225 |
| Fax Number: | 2038694421 |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 09/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 001317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |