Healthcare Provider Details

I. General information

NPI: 1750924429
Provider Name (Legal Business Name): PATRENE RHODEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HYDE AVE STE 109
VERNON CT
06066-4503
US

IV. Provider business mailing address

30 JORDAN LN STE 3
WETHERSFIELD CT
06109-1244
US

V. Phone/Fax

Practice location:
  • Phone: 860-454-0303
  • Fax: 860-875-4242
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8582
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number12.008582
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number082022
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: