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General NPI Number Information
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NPI Number | 1043567647
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Entity Type | Organization
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Legal Business Name | KEYS2MEMORY, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 20 BURROWS ST
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City | MYSTIC
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State | CT
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Zip | 06355-2445
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Country | US
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Telephone | 860-245-4144
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Fax | 860-245-4145
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Provider Business Mailing Address
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Address Line | 23 EAST MAIN ST. PO BOX 625
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City | MYSTIC
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State | CT
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Zip | 06355-0625
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Country | US
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Telephone | 860-245-4144
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Fax | 860-245-4145
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. ELENA SCHJAVLAND
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Credential | APRN
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Telephone | 860-245-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 002017
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 002017
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License Number State | CT
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