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NPI Code Detail

MEDICARE: MRS. MICHELLE MARIE HENRY APRN

MEDICARE: MRS. MICHELLE MARIE HENRY 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
1163W00000XRegistered NurseE59540CT
2363LP0200XPediatric Nurse Practitioner003250CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1030250OTHERCT CARE
2358978OTHERPREFERRED ONE

General Provider Information

NPI Number : 1770636193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE MARIE HENRY APRN
Provider Business Mailing Address
First Line : 20 FELICITY LN
Second Line :
City : TORRINGTON
State : CT
Zip : 06790-6101
Country : US
Telephone Number : 860-489-4144
Fax Number : 860-489-4412
Provider Business Practice Location Address
First Line : 20 FELICITY LN
Second Line :
City : TORRINGTON
State : CT
Zip : 06790-6101
Country : US
Telephone Number : 860-489-4144
Fax Number : 860-489-4412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 03/03/2014

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