Healthcare Provider Details

I. General information

NPI: 1982615258
Provider Name (Legal Business Name): MARGARET BRIGHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SOUTH ST SUITE 101
WEST HARTFORD CT
06110-1960
US

IV. Provider business mailing address

4 FARM SPRINGS RD PROHEALTH PHYSICIANS
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-953-5151
  • Fax: 860-953-9586
Mailing address:
  • Phone: 860-284-5200
  • Fax: 860-284-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000695
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number000695
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: