Healthcare Provider Details

I. General information

NPI: 1164418265
Provider Name (Legal Business Name): AILEEN MARIE DEAMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 WILLARD AVE
NEWINGTON CT
06111
US

IV. Provider business mailing address

25 BUENA VISTA RD
WEST HARTFORD CT
06107-3203
US

V. Phone/Fax

Practice location:
  • Phone: 860-666-6951
  • Fax:
Mailing address:
  • Phone: 860-561-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002169
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: