Active NPI
Traci L Gwiazdowski
- Registered Nurse
- Putnam, CT
National Provider Identifier
1043093073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 112567
- Practice address
- 391 Pomfret St
Putnam, CT 06260-1852 - Phone
- (860) 731-5522
- Fax
- (860) 731-5536
- NPI assigned
- Aug 15, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 112567 | CT | Primary |
Addresses
Primary practice location
391 Pomfret St
Putnam, CT 06260-1852
Mailing address
2 Waterside Xing Ste 401
Windsor, CT 06095-1588
Phone (860) 697-3351
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112567 | CT | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1043093073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 WATERSIDE XING STE 401",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060951588",
"telephone_number": "860-697-3351",
"fax_number": "860-731-5536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "391 POMFRET ST",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062601852",
"telephone_number": "860-731-5522",
"fax_number": "860-731-5536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWIAZDOWSKI",
"first_name": "TRACI",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-15",
"last_updated": "2023-08-15",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CT",
"license": "112567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.