Healthcare Provider Details

I. General information

NPI: 1134482300
Provider Name (Legal Business Name): PAYAL HUMBLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST CARDIOLOGY
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

20 YORK ST SURGICAL INTENSIVE CARE UNIT
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4808
  • Fax:
Mailing address:
  • Phone: 203-688-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5081
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number5081
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number5081
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: