Healthcare Provider Details

I. General information

NPI: 1215962428
Provider Name (Legal Business Name): JOHANNA L MEEHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST CANCER CENTER
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

130 BRAEMAR DR
CHESHIRE CT
06410-1614
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-5554
  • Fax: 860-714-8047
Mailing address:
  • Phone: 203-271-1389
  • Fax: 860-496-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number000843
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number843
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: