Healthcare Provider Details

I. General information

NPI: 1760397822
Provider Name (Legal Business Name): ANNE-MARIE PARADIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOUNDERS ST STE 200
WILLIMANTIC CT
06226-2051
US

IV. Provider business mailing address

109 CAMP MOWEEN RD
LEBANON CT
06249-2730
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-5330
  • Fax:
Mailing address:
  • Phone: 860-608-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83963
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: