Healthcare Provider Details

I. General information

NPI: 1174233498
Provider Name (Legal Business Name): HANNAH YARUM PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LAFAYETTE ST
NEW BRITAIN CT
06051-1803
US

IV. Provider business mailing address

12 VAN BUREN RD
ENFIELD CT
06082-5323
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax:
Mailing address:
  • Phone: 860-977-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12.011282
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.181171
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: