Healthcare Provider Details

I. General information

NPI: 1750650149
Provider Name (Legal Business Name): EMILY A DUFFIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

2 JONATHANS LNDG APT 208
MADISON CT
06443-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-5864
  • Fax: 203-200-4810
Mailing address:
  • Phone: 206-669-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number004863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: