MEDICARE: DR. ELIZABETH MB VISONE DNP, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	002572	CT
2	363LA2200X	Adult Health Nurse Practitioner	002572	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31440	OTHER	CT	ST CONTROLLED SUBSTANCE #
2	002572	OTHER	CT	STATE APRN LICENSE
3	E43356	OTHER	CT	STATE RN LICENSE NUMBER

General Provider Information

NPI Number	:	1114924172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MB VISONE DNP, APRN

Provider Business Mailing Address
First Line	:	1290 SILAS DEANE HWY
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-4337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 DAY HILL RD STE 203
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-5720
Country	:	US
Telephone Number	:	860-696-2450
Fax Number	:	860-696-2460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	03/07/2023

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