Healthcare Provider Details

I. General information

NPI: 1962817908
Provider Name (Legal Business Name): MARY ELIZABETH BYCHOLSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST HARTFORD HOSPITAL NEUROLOGY DEPT
HARTFORD CT
06102-5037
US

IV. Provider business mailing address

80 SEYMOUR ST HARTFORD HOSPITAL NEUROLOGY DEPT
HARTFORD CT
06102-5037
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3621
  • Fax:
Mailing address:
  • Phone: 860-972-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number005769
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number005769
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number005769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: