Healthcare Provider Details

I. General information

NPI: 1245342294
Provider Name (Legal Business Name): MARILYN JANE CLAYTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GRISWOLD ST
NEW BRITAIN CT
06050
US

IV. Provider business mailing address

50 GRISWOLD ST NEW BRITAIN GENERAL HOSPITAL COUNSELING CENTER
NEW BRITAIN CT
06050
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5267
  • Fax: 860-224-5752
Mailing address:
  • Phone: 860-224-5267
  • Fax: 860-224-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE34597
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: