Healthcare Provider Details

I. General information

NPI: 1104330083
Provider Name (Legal Business Name): GERDE B FRANCKLIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD WATERBURY RD STE 108
SOUTHBURY CT
06488-3848
US

IV. Provider business mailing address

68 OLD FARMS LN
NEW MILFORD CT
06776-3704
US

V. Phone/Fax

Practice location:
  • Phone: 203-262-4200
  • Fax:
Mailing address:
  • Phone: 860-210-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7359
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number7359
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: