Healthcare Provider Details

I. General information

NPI: 1346315231
Provider Name (Legal Business Name): CONNECTICUT CLINICAL NURSING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 07/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 KEEGAN RD
PLYMOUTH CT
06782-2608
US

IV. Provider business mailing address

PO BOX 1535
BRISTOL CT
06011-1535
US

V. Phone/Fax

Practice location:
  • Phone: 860-340-8280
  • Fax:
Mailing address:
  • Phone: 860-340-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002938
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number001126
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number002671
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003747
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000638
License Number StateCT

VIII. Authorized Official

Name: CATHERINE MILNE
Title or Position: MEMBER
Credential: APRN
Phone: 860-340-8280