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General NPI Number Information
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NPI Number | 1841832391
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Entity Type | Individual
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Provider Name | ALIX REBECCA WILDER MCKENNA APRN
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Gender | Female
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 800 HOWARD AVENUE
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City | NEW HAVEN
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State | CT
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Zip | 06519
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Country | US
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Telephone | 877-925-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BERNDALE DR
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City | WESTPORT
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State | CT
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Zip | 06880
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Country | US
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Telephone | 858-449-9037
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 147866
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8596
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License Number State | CT
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