Healthcare Provider Details

I. General information

NPI: 1730697293
Provider Name (Legal Business Name): NANA PREMPEH-MANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

925 MIX AVE APT 1I
HAMDEN CT
06514-5118
US

V. Phone/Fax

Practice location:
  • Phone: 800-714-4000
  • Fax:
Mailing address:
  • Phone: 347-330-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7439
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: