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General NPI Number Information
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NPI Number | 1013337179
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Entity Type | Organization
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Legal Business Name | PROFICIENT NURSE PRACTITIONERS PNP
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 24 PARK PL
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City | HARTFORD
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State | CT
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Zip | 06106-5008
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Country | US
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Telephone | 860-558-3720
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Fax |
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Provider Business Mailing Address
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Address Line | 24 PARK PL
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City | HARTFORD
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State | CT
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Zip | 06106
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Country | US
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Telephone | 860-558-3720
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BERESHITH ADAMS
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Credential |
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Telephone | 860-558-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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