Healthcare Provider Details

I. General information

NPI: 1992701122
Provider Name (Legal Business Name): MARGARET FLINTER APRN, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST
CLINTON CT
06413-2112
US

IV. Provider business mailing address

635 MAIN ST ATTN: CREDENTIALING DEPT
MIDDLETOWN CT
06457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0787
  • Fax: 860-664-1982
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000176
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: