Healthcare Provider Details

I. General information

NPI: 1982060158
Provider Name (Legal Business Name): COLLEEN STODDART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST STE 202B
MONROE CT
06468-2284
US

IV. Provider business mailing address

90 KANE ST APT B3
WEST HARTFORD CT
06119-2114
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5335
  • Fax:
Mailing address:
  • Phone: 860-833-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6403
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: