Healthcare Provider Details

I. General information

NPI: 1760009914
Provider Name (Legal Business Name): PAULETTE SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

10 WEDGEWOOD DR APT B1
BLOOMFIELD CT
06002-1937
US

V. Phone/Fax

Practice location:
  • Phone: 888-793-3500
  • Fax:
Mailing address:
  • Phone: 860-371-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number82889
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: