Healthcare Provider Details

I. General information

NPI: 1376538074
Provider Name (Legal Business Name): PATRICIA K BOZEMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA KRAWIEC

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 911
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST SUITE 911
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-4158
  • Fax: 860-524-2652
Mailing address:
  • Phone: 860-522-4158
  • Fax: 860-524-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number003251
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003251
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: