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NPI Code Detail

MEDICARE: VITORIA BASORA APRN

MEDICARE: VITORIA BASORA 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner12016167CT

General Provider Information

NPI Number : 1619642113
Entity Type Code : Individual
Provider Name (Legal Business Name) : VITORIA BASORA APRN
Provider Business Mailing Address
First Line : 8 WRIGHT ST STE 107
Second Line :
City : WESTPORT
State : CT
Zip : 06880-3114
Country : US
Telephone Number : 475-252-5723
Fax Number : 475-275-7166
Provider Business Practice Location Address
First Line : 8 WRIGHT ST STE 107
Second Line :
City : WESTPORT
State : CT
Zip : 06880-3114
Country : US
Telephone Number : 475-252-5723
Fax Number : 475-275-7166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 06/15/2026

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