Healthcare Provider Details

I. General information

NPI: 1144320557
Provider Name (Legal Business Name): REBECCA A. FAIRCHILD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA A. ALBRIGHT CRNP

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4338
  • Fax:
Mailing address:
  • Phone: 860-972-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007209
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9350
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: