Healthcare Provider Details

I. General information

NPI: 1689767238
Provider Name (Legal Business Name): PATTY ELAINE HARRIS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S. MAIN STREET
WALLINGFORD CT
06492
US

IV. Provider business mailing address

116 S. MAIN STREET
WALLINGFORD CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3347
  • Fax: 203-265-3651
Mailing address:
  • Phone: 203-265-3347
  • Fax: 203-265-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001292
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001292
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: