Healthcare Provider Details

I. General information

NPI: 1235667502
Provider Name (Legal Business Name): SERA GADBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 VINE ST
NEW BRITAIN CT
06052-1431
US

IV. Provider business mailing address

74 FORTIN DR
BROOKLYN CT
06234-3823
US

V. Phone/Fax

Practice location:
  • Phone: 860-230-5344
  • Fax:
Mailing address:
  • Phone: 860-230-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: