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General NPI Number Information
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NPI Number | 1184334633
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Entity Type | Individual
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Provider Name | MISS ITORO JOSEPH ETIM
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Gender | Female
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 816 BROAD ST
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City | MERIDEN
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State | CT
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Zip | 06450-4350
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Country | US
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Telephone | 203-238-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 547 N ELM ST
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City | WALLINGFORD
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State | CT
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Zip | 06492-3268
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Country | US
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Telephone | 860-508-8587
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11263
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License Number State | CT
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