Healthcare Provider Details

I. General information

NPI: 1235657040
Provider Name (Legal Business Name): CHRISTY CHASE DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MOUNT CARMEL AVE
HAMDEN CT
06518-1961
US

IV. Provider business mailing address

275 MOUNT CARMEL AVENUE QUINNIPIAC UNIVERSITY, STUDENT HEALTH SERVICES
HAMDEN CT
06518-1961
US

V. Phone/Fax

Practice location:
  • Phone: 203-582-8738
  • Fax:
Mailing address:
  • Phone: 203-582-8738
  • Fax: 203-582-8924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7199
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: