Healthcare Provider Details

I. General information

NPI: 1174949572
Provider Name (Legal Business Name): ANNA GUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 CROMWELL AVE # 101
ROCKY HILL CT
06067-1800
US

IV. Provider business mailing address

546 CROMWELL AVE # 101
ROCKY HILL CT
06067-1800
US

V. Phone/Fax

Practice location:
  • Phone: 860-757-3874
  • Fax: 860-757-3875
Mailing address:
  • Phone: 860-757-3874
  • Fax: 860-757-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number001319
License Number StateCT

VIII. Authorized Official

Name: ANNA GUT
Title or Position: OWNER
Credential: APRN
Phone: 860-757-3874