Healthcare Provider Details

I. General information

NPI: 1609849892
Provider Name (Legal Business Name): ASSOCIATES FOR WOMEN'S WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 WEST STAFFORD ROAD III
STAFFORD SPRINGS CT
06076-1000
US

IV. Provider business mailing address

72 WEST STAFFORD ROAD III
STAFFORD SPRINGS CT
06076
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-5770
  • Fax:
Mailing address:
  • Phone: 860-684-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000188
License Number StateCT

VIII. Authorized Official

Name: DONNA M LOWNEY
Title or Position: OWNER
Credential: CNM
Phone: 860-684-5770