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General NPI Number Information
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NPI Number | 1619567260
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALTHCARE OF CONNECTICUT LLC
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 112 SPENCER ST STE 2A
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City | MANCHESTER
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State | CT
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Zip | 06040-4601
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Country | US
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Telephone | 860-791-8170
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Fax | 860-791-8208
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Provider Business Mailing Address
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Address Line | 112 SPENCER ST STE 2A
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City | MANCHESTER
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State | CT
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Zip | 06040-4601
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Country | US
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Telephone | 860-791-8170
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Fax | 860-791-8208
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | CAMYLLE APPIAHENE
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Credential | MSN, APRN, NP-C
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Telephone | 860-985-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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