Healthcare Provider Details

I. General information

NPI: 1114476546
Provider Name (Legal Business Name): CHRISTOPHER DEFRANCESCO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BOSTON POST RD STE 2F
ORANGE CT
06477-3504
US

IV. Provider business mailing address

226 MILL HILL AVE 3RD FLOOR
BRIDGEPORT CT
06610-2826
US

V. Phone/Fax

Practice location:
  • Phone: 203-795-0568
  • Fax:
Mailing address:
  • Phone: 203-795-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number006780
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: