=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235177031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRA A BECKER-MUSANTE APRN,NMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 MAIN ST STE 7
-----------------------------------------------------
City | ELLINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06029-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-572-7711
-----------------------------------------------------
Fax | 860-574-9014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 MAIN ST STE 7
-----------------------------------------------------
City | ELLINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06029-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-572-7711
-----------------------------------------------------
Fax | 860-574-9014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 3736
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------