Healthcare Provider Details

I. General information

NPI: 1760117188
Provider Name (Legal Business Name): AMBER LYNN RICH ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

42 HOMESTEAD LN
BROOKFIELD CT
06804-2611
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4127
  • Fax:
Mailing address:
  • Phone: 203-520-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number144463
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432470
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11003
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: