Healthcare Provider Details

I. General information

NPI: 1083522072
Provider Name (Legal Business Name): GILLIAN MARY O'CALLAGHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SYCAMORE ST STE 100
GLASTONBURY CT
06033-7208
US

IV. Provider business mailing address

30 JORDAN LANE
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-0581
  • Fax: 860-657-1806
Mailing address:
  • Phone: 860-845-0905
  • Fax: 860-913-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18157
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: