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General NPI Number Information
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NPI Number | 1003177163
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Entity Type | Individual
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Provider Name | CHARIS WIPFLER
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 56 FRANKLIN ST
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City | WATERBURY
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State | CT
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Zip | 06706-1253
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Country | US
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Telephone | 860-709-6140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | WINDSOR
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State | CT
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Zip | 06095-6190
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Country | US
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Telephone | 800-925-7270
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Fax | 888-331-1015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 005039
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License Number State | CT
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