MEDICARE: MARIA ANNA M GO 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	363LA2200X	Adult Health Nurse Practitioner	003310	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790769107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ANNA M GO APRN

Provider Business Mailing Address
First Line	:	130 BRENTWOOD DR
Second Line	:
City	:	CHESHIRE
State	:	CT
Zip	:	06410-3440
Country	:	US
Telephone Number	:	203-272-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	EVERCARE
Second Line	:	450 COLUMBUS AVENUE
City	:	HARTFORD
State	:	CT
Zip	:	06103-6270
Country	:	US
Telephone Number	:	860-874-4552
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/13/2023

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