MEDICARE: DEENA BABIGIAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	001330	CT

General Provider Information

NPI Number	:	1285781369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENA BABIGIAN APRN

Provider Business Mailing Address
First Line	:	4 FARM SPRINGS RD
Second Line	:	PROHEALTH PHYSICIANS
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2573
Country	:	US
Telephone Number	:	860-284-5200
Fax Number	:	860-284-5333

Provider Business Practice Location Address
First Line	:	200 BLOOMFIELD AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1545
Country	:	US
Telephone Number	:	860-284-5200
Fax Number	:	860-284-5333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/04/2007

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