Healthcare Provider Details

I. General information

NPI: 1801759774
Provider Name (Legal Business Name): ERIK NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2870
US

IV. Provider business mailing address

72 BROOKDALE RD
SEYMOUR CT
06483-2430
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number10.144453
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: