Healthcare Provider Details

I. General information

NPI: 1013564905
Provider Name (Legal Business Name): CHRISTIE LEE VARDHAMI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VINE ST
HARTFORD CT
06112-1639
US

IV. Provider business mailing address

500 VINE ST
HARTFORD CT
06112-1639
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-0800
  • Fax:
Mailing address:
  • Phone: 860-297-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8433
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: