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General NPI Number Information
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NPI Number | 1043520604
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Entity Type | Organization
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Legal Business Name | DONNA CIVARDI RNFA, APRN, FNP-BC, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 18 ONECO ST SUITE 2
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City | NORWICH
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State | CT
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Zip | 06360-3440
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Country | US
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Telephone | 860-383-2024
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Fax |
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Provider Business Mailing Address
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Address Line | 18 ONECO ST SUITE 2
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City | NORWICH
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State | CT
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Zip | 06360-3440
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Country | US
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Telephone | 860-383-2024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONNA M CIVARDI
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Credential | APRN, FNP-BC
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Telephone | 860-383-2024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 004438
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License Number State | CT
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