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General NPI Number Information
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NPI Number | 1275137531
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Entity Type | Individual
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Provider Name | MRS. JOYAMMA MATHEW
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Gender | Female
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 687 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-3774
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Country | US
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Telephone | 203-932-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 23 DORIS DR
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City | MONROE
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State | CT
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Zip | 06468-2106
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Country | US
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Telephone | 203-543-6934
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG11200064
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9415
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License Number State | CT
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