Healthcare Provider Details

I. General information

NPI: 1588032866
Provider Name (Legal Business Name): SIOBHAN HARDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 4307A
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

1000 ASYLUM AVENUE
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4085
  • Fax:
Mailing address:
  • Phone: 508-737-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6307
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: