Healthcare Provider Details

I. General information

NPI: 1194334359
Provider Name (Legal Business Name): NELSON LEACH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BERWYN ST
MILFORD CT
06461-4010
US

IV. Provider business mailing address

793 POST RD E STE A204
WESTPORT CT
06880-5243
US

V. Phone/Fax

Practice location:
  • Phone: 203-571-3233
  • Fax: 801-752-0632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8964
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8964
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number8964
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8964
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: