KARIN A PROVOST DO (Credential# 365645) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2008. The license expiration date date is February 28, 2009. The license status is INACTIVE.
KARIN A PROVOST DO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0034754. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2008. The expiration date is February 28, 2009. The business address is 27 Randolph St, Wallingford, CT 06492. The current status is inactive.
| Licensee Name | KARIN A PROVOST DO |
| Credential ID | 365645 |
| Credential Number | CSP.0034754 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
27 Randolph St Wallingford CT 06492 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Issue Date | 2004-05-14 |
| Effective Date | 2008-03-01 |
| Expiration Date | 2009-02-28 |
| Refresh Date | 2011-01-12 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 559982 | 1.042400-DO | Physician/Surgeon | 2004-05-04 | 2007-05-31 - 2008-05-31 | INACTIVE |
| Street Address | 27 RANDOLPH ST |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Maley W Hunt | 27 Randolph St, Wallingford, CT 06492-4509 | Nursing Home Administrator | 2018-08-01 ~ 2020-07-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Andrea Zola | 53 Alison Ave., Wallingford, CT 06492 | Esthetician | ~ |
| Kyungok Choi | 90 Ward St, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Giang Nguyen | 45 Country Club Lane, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2021-11-30 |
| Lc Artistry | 207 North Colony Road, Wallingford, CT 06492 | Esthetician | ~ |
| Katie Lee | 20 Angela Dr, Wallingford, CT 06492 | Paramedic | 2020-09-01 ~ 2021-08-31 |
| Vinny's Deli | 567 Center St, Wallingford, CT 06492 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Michele Ruggiero | 26 Leigus Road, Wallingford, CT 06492 | Radiographer | 2020-07-01 ~ 2021-06-30 |
| Dianna K Ball | 104 Simpson Ave, Wallingford, CT 06492 | Speech and Language Pathologist | 2020-08-01 ~ 2021-07-31 |
| Ann Marie Richardson | 20 Mohawk Drive, Wallingford, CT 06492 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Joann Hummel | 60 Deer Run Road, Wallingford, CT 06492 | Medication Administration Certification | 2018-08-21 ~ 2020-08-20 |
| Find all Licenses in zip 06492 | |||
| City | WALLINGFORD |
| Zip Code | 06492 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WALLINGFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Renee M Provost | 25 Oak Lane, Bloomfield, CT 06002 | Controlled Substance Registration for Practitioner | 2017-12-28 ~ 2019-02-28 |
| Justin A Provost | 40 Prospect Ave Bldg1 Apt 4h, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Karin L Harter | 218 Woodlawn Dr, Seymour, CT 06483-2469 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Karin K Augur | 407 Forest Rd, Northford, CT 06472-1526 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Karin Grambow Dvm | 65 Dorothy Dr, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2004-02-29 ~ 2005-02-28 |
| Karin E Grann | 103 E Shore Dr, Colchester, CT 06415-5218 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Karin E Kerfoot Md | 865 Orange St, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Karin Michels-ashwood | 26 Hamilton Ct, Fairfield, CT 06824-7831 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Karin L Witt | 49 Crescent Street, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
| Karin A Sloan Md | 21 Follen St Number 4, Boston, MA 02116 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
Please comment or provide details below to improve the information on KARIN A PROVOST DO.
| 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).