Healthcare Provider Details

I. General information

NPI: 1801758552
Provider Name (Legal Business Name): JENNIFER MONAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTHWESTERN DR STE 101
BLOOMFIELD CT
06002-3400
US

IV. Provider business mailing address

38 HALEY MEADOW RD
GRISWOLD CT
06351-1155
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-4862
  • Fax: 860-760-5719
Mailing address:
  • Phone: 860-617-6699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15238
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: