Healthcare Provider Details

I. General information

NPI: 1487858361
Provider Name (Legal Business Name): MELINDA ETHEL BROCKWELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

8 LOWLYN DR
WESTPORT CT
06880-1829
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2148
  • Fax: 203-852-3109
Mailing address:
  • Phone: 203-226-0650
  • Fax: 203-852-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number003545
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: