Healthcare Provider Details

I. General information

NPI: 1184798480
Provider Name (Legal Business Name): CATHARINE MOFFETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANKLIN ST
NEW LONDON CT
06320-5920
US

IV. Provider business mailing address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-5820
  • Fax: 860-447-3177
Mailing address:
  • Phone: 203-752-2856
  • Fax: 203-752-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000831
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: