Healthcare Provider Details

I. General information

NPI: 1871925487
Provider Name (Legal Business Name): MONICA MARIE BACKIEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 SILAS DEANE HWY
WETHERSFIELD CT
06109-4302
US

IV. Provider business mailing address

34 SUMMIT ST
NEWINGTON CT
06111-1711
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-8659
  • Fax:
Mailing address:
  • Phone: 860-570-0162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5410
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: