Healthcare Provider Details

I. General information

NPI: 1982909594
Provider Name (Legal Business Name): WENDY R LORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET
HARTFORD CT
06141-0540
US

IV. Provider business mailing address

99 E RIVER DR 5TH FLOOR
EAST HARTFORD CT
06108-3288
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-2117
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4575
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: