Healthcare Provider Details

I. General information

NPI: 1669649588
Provider Name (Legal Business Name): ELIZABETH H ANDERSON A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BROWNELL AVE
HARTFORD CT
06106-3302
US

IV. Provider business mailing address

205 VERNON AVENUE #163
VERNON CT
06066
US

V. Phone/Fax

Practice location:
  • Phone: 860-244-3876
  • Fax:
Mailing address:
  • Phone: 860-454-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001869
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001869
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: