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General NPI Number Information
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NPI Number | 1982192209
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Entity Type | Individual
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Provider Name | TARANNUM MALWAT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 01/20/2019
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Provider Practice Location Address
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Address Line | 396 CROMWELL AVE
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City | ROCKY HILL
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State | CT
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Zip | 06067
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Country | US
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Telephone | 860-372-4990
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Fax |
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Provider Business Mailing Address
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Address Line | 39 BUCKLAND ST APT 1112-4
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City | MANCHESTER
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State | CT
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Zip | 06042-7721
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7488
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License Number State | CT
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