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General NPI Number Information
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NPI Number | 1730697293
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Entity Type | Individual
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Provider Name | NANA PREMPEH-MANN CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 800-714-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 925 MIX AVE APT 1I
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City | HAMDEN
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State | CT
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Zip | 06514-5118
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Country | US
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Telephone | 347-330-0679
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7439
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License Number State | CT
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