Healthcare Provider Details

I. General information

NPI: 1194614255
Provider Name (Legal Business Name): ANWAR ESAM ABDULREHMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BROOKSIDE RD
WATERBURY CT
06708-1402
US

IV. Provider business mailing address

7 SHANNON RDG
DANBURY CT
06810-6326
US

V. Phone/Fax

Practice location:
  • Phone: 203-568-7474
  • Fax:
Mailing address:
  • Phone: 203-770-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14982
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: