Healthcare Provider Details

I. General information

NPI: 1780875278
Provider Name (Legal Business Name): CHRIS T MALINOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WETHERSFIELD AVE
HARTFORD CT
06114
US

IV. Provider business mailing address

1680 ALBANY AVE
HARTFORD CT
06114
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-0562
  • Fax: 860-523-4805
Mailing address:
  • Phone: 860-297-0062
  • Fax: 860-523-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001269
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE37011
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: