KRYSTN R WAGNER (Credential# 317384) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KRYSTN R WAGNER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0032605. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 374 Grand Ave, New Haven, CT 06513-3733. The current status is active.
| Licensee Name | KRYSTN R WAGNER |
| Credential ID | 317384 |
| Credential Number | CSP.0032605 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
374 Grand Ave New Haven CT 06513-3733 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2002-08-12 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-25 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 558214 | 1.040631 | Physician/Surgeon | 2002-07-08 | 2020-02-01 - 2021-01-31 | ACTIVE |
| Street Address | 374 GRAND AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06513-3733 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jennifer B Yaro | 374 Grand Ave, New Haven, CT 06513-3733 | Advanced Practice Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Kyle T Elligers | 374 Grand Ave, New Haven, CT 06513-3733 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Douglas Olson | 374 Grand Ave, New Haven, CT 06513-3733 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Eileen F Keane | 374 Grand Ave, New Haven, CT 06513 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Marissa C Bayerl | 374 Grand Ave, New Haven, CT 06513-3733 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Amanda E Decew | 374 Grand Ave, New Haven, CT 06513 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Suzanne P Lagarde | 374 Grand Ave, New Haven, CT 06513-3733 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| James E Seely Md | 374 Grand Ave, New Haven, CT 06513-3733 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Fair Haven Community Health Care | 374 Grand Ave, New Haven, CT 06513-3733 | Substance Abuse | 2018-10-01 ~ 2020-09-30 |
| Fair Haven Community Health Clinic Inc. · Fair Haven Community Health Center | 374 Grand Ave, New Haven, CT 06513-3733 | Outpatient Clinic | 2016-10-01 ~ 2020-09-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nazreat H Teklemicael | 386 Grand Ave # 2r, New Haven, CT 06513-3733 | Family Child Care Home | 2018-12-06 ~ 2022-12-31 |
| Kimberly Westerband | 382 Grand Ave Apt 3l, New Haven, CT 06513-3733 | Pharmacy Technician | 2019-09-17 ~ 2020-03-31 |
| New Haven Pharmacy Inc | 382 Grand Ave, New Haven, CT 06513-3733 | Non Legend Drug Permit | 2020-01-01 ~ 2020-12-31 |
| Sheilla Nortey Asiedu | 382 Grand Ave Apt 21, New Haven, CT 06513-3733 | Licensed Practical Nurse | 2012-01-20 ~ 2012-11-30 |
| Meghanada Yerkam | 382 Grand Ave, New Haven, CT 06513-3733 | Pharmacy Technician | 2019-04-01 ~ 2020-03-31 |
| Zulma O Huerta | 382 Grand Ave, New Haven, CT 06513-3733 | Pharmacy Technician | 2013-10-03 ~ 2014-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Odalys Guartan | 17 Dell Dr, East Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-06-30 |
| Marilu E Espinsa | 148 Poplar St, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Javon Christian Woodard | 404 Poplar St, New Haven, CT 06513 | Registered Nurse | ~ |
| Norma Congacha | 22 Farren Ave., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-05-31 |
| Sonia Sunanita Salazar | 48 Wolcott St 1 L., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Rosa Zuna | 426 Ferry St. 1st Fl, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Veronica Congacha | 28 Farren Ave., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Jessica L Vallejo | 41 Oak Ridge Dr, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2022-02-28 |
| Ami Nosenzo · Nosenzo | 1423 Quinnipiac Ave, New Haven, CT 06513 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Taquetta Delis Mitchell | 40 Foxon Hill Rd I34, New Haven, CT 06513 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06513 | |||
| City | NEW HAVEN |
| Zip Code | 06513 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW HAVEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Thomas J Wagner | 540 Route 148, Killingworth, CT 06419 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jessica L Wagner | 227 Church St Apt 7c, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Brian K Wagner | 11 South Rd, Farmington, CT 06032-2483 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Cliff Wagner Md | 161 Talcott Notch Rd, Farmington, CT 06032 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Joseph R Wagner Md | 85 Seymour St Suite 416, Hartford, CT 06106 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Matthew P Wagner | 1450 Chapel St, New Haven, CT 06511-4405 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Peter John Wagner | 162 Dawley Dr., Stonington, CT 06378 | Controlled Substance Registration for Practitioner | 2019-04-02 ~ 2021-02-28 |
| Annette V Wagner Md | 7 Niagara Pier, Erie, PA 16507 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Todd L Wagner Do | 40 Middlefield St, Groton Long Pt, CT 06340 | Controlled Substance Registration for Practitioner | ~ 2001-02-28 |
| James L. Wagner | 1608 Riverview Rd, Chattanooga, TN 37405-3131 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
Please comment or provide details below to improve the information on KRYSTN R WAGNER.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).