Healthcare Provider Details

I. General information

NPI: 1790284164
Provider Name (Legal Business Name): GEORGINA TWUMASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 E CENTER ST
MANCHESTER CT
06040-4472
US

IV. Provider business mailing address

357 E CENTER ST
MANCHESTER CT
06040-4472
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-0616
  • Fax:
Mailing address:
  • Phone: 860-288-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number007447
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: