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General NPI Number Information
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NPI Number | 1063212140
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Entity Type | Individual
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Provider Name | JOANNA MARIA STACHOWICZ RN
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 35 THORPE AVE STE 104
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City | WALLINGFORD
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State | CT
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Zip | 06492-1948
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Country | US
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Telephone | 203-779-5799
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Fax |
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Provider Business Mailing Address
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Address Line | 48 TAFT POND RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259-1317
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Country | US
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Telephone | 774-280-6124
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 205971
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License Number State | CT
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