Healthcare Provider Details

I. General information

NPI: 1679537757
Provider Name (Legal Business Name): HEATHER MOKOTOFF APRN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OLD DAIRY RD
TRUMBULL CT
06611-4967
US

IV. Provider business mailing address

50 OLD DAIRY RD
TRUMBULL CT
06611-4967
US

V. Phone/Fax

Practice location:
  • Phone: 203-583-2534
  • Fax:
Mailing address:
  • Phone: 203-583-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number003261
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: