Healthcare Provider Details

I. General information

NPI: 1497188163
Provider Name (Legal Business Name): WAYNE ROCKHILL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708
US

IV. Provider business mailing address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone: 203-573-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number005467
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number005467
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: