Healthcare Provider Details

I. General information

NPI: 1285330092
Provider Name (Legal Business Name): HEATHER MARIE CIOS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WESTERN BLVD STE A
GLASTONBURY CT
06033-4305
US

IV. Provider business mailing address

42 THOMPSON ST
SOUTH GLASTONBURY CT
06073-2913
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-1920
  • Fax:
Mailing address:
  • Phone: 860-462-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11536
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: