Healthcare Provider Details

I. General information

NPI: 1457724056
Provider Name (Legal Business Name): FAIRFIELD HEALTH AND WELLNESS SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST SUITE 203A
MONROE CT
06468-2280
US

IV. Provider business mailing address

324 ELM ST SUITE 203A
MONROE CT
06468-2280
US

V. Phone/Fax

Practice location:
  • Phone: 203-220-6306
  • Fax: 203-220-6308
Mailing address:
  • Phone: 203-220-6306
  • Fax: 203-220-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number001767
License Number StateCT

VIII. Authorized Official

Name: MRS. DEENNA MONICA NEALON
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APRN
Phone: 203-220-6306