Healthcare Provider Details

I. General information

NPI: 1124316419
Provider Name (Legal Business Name): CHRISTINE M RAYMOND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-2212
US

IV. Provider business mailing address

49 ASPETUCK PINES DR
NEW MILFORD CT
06776-5126
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-1186
  • Fax:
Mailing address:
  • Phone: 860-488-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number12.004691
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: