Healthcare Provider Details

I. General information

NPI: 1851457659
Provider Name (Legal Business Name): FRIEDA WINNICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL TRAUMA PROGRAM
HARTFORD CT
06102
US

IV. Provider business mailing address

HARTFORD HOSPITAL PROFESSIONAL SERVICES PO BOX 40,000 DEPT 634
HARTFORD CT
06151-0634
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-3112
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002672
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002672
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: