=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396970158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODD A PERKINS APRN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2009
-----------------------------------------------------
Last Update Date | 05/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 N MAIN ST SUITE 2A
-----------------------------------------------------
City | SOUTHINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06489-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-276-3000
-----------------------------------------------------
Fax | 860-276-3002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 N MAIN ST SUITE 2A
-----------------------------------------------------
City | SOUTHINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06489-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-276-3000
-----------------------------------------------------
Fax | 860-276-3002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | TODD A PERKINS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 860-276-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 003219
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------