Healthcare Provider Details

I. General information

NPI: 1891199980
Provider Name (Legal Business Name): ELISABETH HENVY ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MILL HILL AVE
BRIDGEPORT CT
06610-2826
US

IV. Provider business mailing address

23 ELIZABETH ST
BETHEL CT
06801-2109
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3388
  • Fax: 203-384-4034
Mailing address:
  • Phone: 203-948-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number005876
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: