Healthcare Provider Details

I. General information

NPI: 1609093921
Provider Name (Legal Business Name): ELAINE MCKEMMIE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
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: 860-290-4142
Mailing address:
  • Phone: 860-528-1359
  • Fax: 860-290-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number063114
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000737
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: