Healthcare Provider Details

I. General information

NPI: 1134754369
Provider Name (Legal Business Name): REBECCA CHING APRN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST FL 1
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

87 CARLI BLVD
COLCHESTER CT
06415-1876
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-6661
  • Fax:
Mailing address:
  • Phone: 860-912-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number12.009035
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.116419
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: