Healthcare Provider Details

I. General information

NPI: 1386555233
Provider Name (Legal Business Name): HOME RHEUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 ALBANY AVE
HARTFORD CT
06112-2110
US

IV. Provider business mailing address

32 FAIRFIELD LN
BLOOMFIELD CT
06002-1994
US

V. Phone/Fax

Practice location:
  • Phone: 860-655-0443
  • Fax:
Mailing address:
  • Phone: 860-655-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAULINE PATRICIA WILKS
Title or Position: MANAGER
Credential: FNP-BC
Phone: 860-655-0443