Healthcare Provider Details

I. General information

NPI: 1043972961
Provider Name (Legal Business Name): NICOLA NATALIE NELSON-PEPKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SEABURY DR
BLOOMFIELD CT
06002-2661
US

IV. Provider business mailing address

250 SEABURY DR
BLOOMFIELD CT
06002-2661
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-6074
  • Fax:
Mailing address:
  • Phone: 860-243-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number151957
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: