Healthcare Provider Details

I. General information

NPI: 1093154957
Provider Name (Legal Business Name): DOROTHY VIVIAN ESPOSITO ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST
MONROE CT
06468-2280
US

IV. Provider business mailing address

324 ELM ST
MONROE CT
06468-2280
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5335
  • Fax:
Mailing address:
  • Phone: 203-880-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306453
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: