Healthcare Provider Details

I. General information

NPI: 1447925128
Provider Name (Legal Business Name): ANGELA DEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 MAIN ST STE 202
EAST HARTFORD CT
06108-2293
US

IV. Provider business mailing address

30 JORDAN LANE
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-4124
  • Fax: 860-282-1213
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9640
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9640
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: