Healthcare Provider Details

I. General information

NPI: 1508024894
Provider Name (Legal Business Name): WENDY MIEKO MURAKAMI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E CENTER ST
MANCHESTER CT
06040-4445
US

IV. Provider business mailing address

49 HARTFORD TPKE
VERNON CT
06066-5242
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-0166
  • Fax: 860-645-7534
Mailing address:
  • Phone: 860-646-0166
  • Fax: 860-645-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number184911
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1156
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number001156
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR50878
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: