Healthcare Provider Details

I. General information

NPI: 1154951341
Provider Name (Legal Business Name): CHRISTINA DEVI DRELICHOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2600
US

IV. Provider business mailing address

282 LAKE SHORE DR
MIDDLEBURY CT
06762-3400
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6205
  • Fax:
Mailing address:
  • Phone: 203-577-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8427
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8427
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: