Healthcare Provider Details

I. General information

NPI: 1023595147
Provider Name (Legal Business Name): NIGEL RODNEY NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRAND ST
HARTFORD CT
06106-1541
US

IV. Provider business mailing address

77 SHADOW LN
WEST HARTFORD CT
06110-1643
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-7500
  • Fax:
Mailing address:
  • Phone: 860-680-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7705
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7705
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: