Healthcare Provider Details

I. General information

NPI: 1659783884
Provider Name (Legal Business Name): ELLEN O. DUELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BLUE HILLS AVE/ WOUND CARE CENTER ST. FRANCIS MEDICAL GROUP, INC
HARTFORD CT
06112-1500
US

IV. Provider business mailing address

500 BLUE HILLS AVE/ WOUND CARE CENTER SAINT FRANCIS MEDICAL GROUP, INC
HARTFORD CT
06112-1500
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-3010
  • Fax:
Mailing address:
  • Phone: 860-714-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001716
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: