Healthcare Provider Details

I. General information

NPI: 1689047698
Provider Name (Legal Business Name): DOROTA URBAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTA URBAN FNP-BC, PMHNP-BC

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 09/25/2023
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W JOHNSON AVE UNIT 304
CHESHIRE CT
06410-4505
US

IV. Provider business mailing address

609 W JOHNSON AVE UNIT 304
CHESHIRE CT
06410-4505
US

V. Phone/Fax

Practice location:
  • Phone: 860-348-3668
  • Fax:
Mailing address:
  • Phone: 860-348-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.006382
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6382
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: