Healthcare Provider Details

I. General information

NPI: 1811975238
Provider Name (Legal Business Name): BETH E. CHENEY A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 125
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST SUITE 125
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-0090
  • Fax: 860-696-0095
Mailing address:
  • Phone: 860-696-0090
  • Fax: 860-696-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000278
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: