Healthcare Provider Details

I. General information

NPI: 1215011770
Provider Name (Legal Business Name): JANE Z REARDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL MEDICINE DEPT
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: 860-545-0123
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number000885
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: