Healthcare Provider Details

I. General information

NPI: 1447336839
Provider Name (Legal Business Name): PRISCILLA ELLEN QUILTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CASE ST SUITE 313
NORWICH CT
06360-2222
US

IV. Provider business mailing address

12 CASE ST SUITE 313
NORWICH CT
06360-2222
US

V. Phone/Fax

Practice location:
  • Phone: 860-204-9126
  • Fax: 860-204-9146
Mailing address:
  • Phone: 860-204-9126
  • Fax: 860-204-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003276
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number003276
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: