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General NPI Number Information
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NPI Number | 1104445352
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Entity Type | Organization
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Legal Business Name | HEALTHYKIDSNE, PLLC
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 763BURNSIDE AVENUE
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City | EAST HARTFORD
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State | CT
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Zip | 06108
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Country | US
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Telephone | 860-573-7682
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Fax |
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Provider Business Mailing Address
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Address Line | 763BURNSIDE AVENUE
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City | EAST HARTFORD
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State | CT
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Zip | 06108
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Country | US
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Telephone | 860-573-7682
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DEBORAH J POERIO
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Credential | DNP, APRN, FNP-BC
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Telephone | 860-573-7682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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