Healthcare Provider Details

I. General information

NPI: 1083808521
Provider Name (Legal Business Name): NORTH STONINGTON MEDICAL WALK-IN CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 NORWICH WESTERLY RD
NORTH STONINGTON CT
06359-1744
US

IV. Provider business mailing address

82 NORWICH WESTERLY RD
NORTH STONINGTON CT
06359-1744
US

V. Phone/Fax

Practice location:
  • Phone: 860-599-2469
  • Fax: 860-599-2830
Mailing address:
  • Phone: 860-599-2469
  • Fax: 860-599-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDY EDWARDS
Title or Position: OFFICE MANAGER
Credential: CPC
Phone: 860-599-2469