Healthcare Provider Details

I. General information

NPI: 1881321156
Provider Name (Legal Business Name): JUDITH BURCHELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 BURNSIDE AVE
EAST HARTFORD CT
06108-2425
US

IV. Provider business mailing address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax:
Mailing address:
  • Phone: 860-983-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10617
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: