Healthcare Provider Details

I. General information

NPI: 1851571244
Provider Name (Legal Business Name): EILEEN HANRAHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE
WILLIMANTIC CT
06226-2027
US

IV. Provider business mailing address

66 SHORE RD
OLD LYME CT
06371-1637
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2661
  • Fax:
Mailing address:
  • Phone: 860-434-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003105
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: