Healthcare Provider Details

I. General information

NPI: 1073099420
Provider Name (Legal Business Name): NICOLE D PARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SILVER LN FL 3
TRUMBULL CT
06611-5343
US

IV. Provider business mailing address

52 HILLSIDE AVE
WEST HAVEN CT
06516-6706
US

V. Phone/Fax

Practice location:
  • Phone: 203-380-5270
  • Fax:
Mailing address:
  • Phone: 203-887-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7858
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: