Healthcare Provider Details

I. General information

NPI: 1609459601
Provider Name (Legal Business Name): ANNA BOHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SILENT GRV
WESTPORT CT
06880-2228
US

IV. Provider business mailing address

17 PEBBLE RD
NEWTOWN CT
06470-2229
US

V. Phone/Fax

Practice location:
  • Phone: 203-751-1144
  • Fax:
Mailing address:
  • Phone: 203-751-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number142649
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number142649
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: