Healthcare Provider Details

I. General information

NPI: 1447481981
Provider Name (Legal Business Name): AUBREY A HEPNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY A WAYNELOVICH

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE CRITICAL CARE MEDICINE
FARMINGTON CT
06030-2200
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT OFFICE
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3107
  • Fax: 860-679-1843
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004132
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: