Healthcare Provider Details

I. General information

NPI: 1861771958
Provider Name (Legal Business Name): CATHERINE CALLAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

65 DANFORTH LN
WEST HARTFORD CT
06110-2430
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5900
  • Fax: 860-224-5749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4728
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: