Healthcare Provider Details

I. General information

NPI: 1831294321
Provider Name (Legal Business Name): DEANNE RENDOCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 923
HARTFORD CT
06106
US

IV. Provider business mailing address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-547-1876
  • Fax: 860-520-1379
Mailing address:
  • Phone: 860-258-3480
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number002313
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: