Healthcare Provider Details

I. General information

NPI: 1609788744
Provider Name (Legal Business Name): ELBA DARIA MULLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

IV. Provider business mailing address

207 REDSTONE HILL RD
BRISTOL CT
06010-7773
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-1124
  • Fax: 860-724-2539
Mailing address:
  • Phone: 203-592-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE56327
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: