Healthcare Provider Details

I. General information

NPI: 1710923719
Provider Name (Legal Business Name): EMILY KEANE-LAYMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PRINCE ST
NEW HAVEN CT
06519-1600
US

IV. Provider business mailing address

2989 DIXWELL AVE
HAMDEN CT
06518-3501
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-0011
  • Fax:
Mailing address:
  • Phone: 203-248-3013
  • Fax: 203-248-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR38921
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: