Healthcare Provider Details

I. General information

NPI: 1023409711
Provider Name (Legal Business Name): KEISHA MCFARLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST SUITE 502
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0549
  • Fax: 860-545-5221
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6065
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: