Healthcare Provider Details

I. General information

NPI: 1508898800
Provider Name (Legal Business Name): GRETCHEN TOUMA MICHAELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 ELLINGTON RD STE 1
SOUTH WINDSOR CT
06074
US

IV. Provider business mailing address

185 PIERCE RD
SOUTH WINDSOR CT
06074-2633
US

V. Phone/Fax

Practice location:
  • Phone: 860-263-3603
  • Fax: 860-254-6167
Mailing address:
  • Phone: 860-805-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number074698
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number241128
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003107
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: