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General NPI Number Information
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NPI Number | 1407318637
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Entity Type | Individual
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Provider Name | DOMENICK BIANCHI APRN
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 201 CHESTNUT HILL RD
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4005
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Country | US
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Telephone | 413-455-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 103 STAFFORD ST
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4336
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Country | US
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Telephone | 413-455-6638
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 8139
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License Number State | CT
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