Basic Information
Provider Information | |||||||||
NPI: | 1164654554 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUNT | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REGAN | ||||||||
OtherFirstName: | SARA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 5 PERRYRIDGE RD | ||||||||
Address2: |   | ||||||||
City: | GREENWICH | ||||||||
State: | CT | ||||||||
PostalCode: | 068304608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2038633615 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 SHAWS CV | ||||||||
Address2: |   | ||||||||
City: | NEW LONDON | ||||||||
State: | CT | ||||||||
PostalCode: | 063204902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8604478304 | ||||||||
FaxNumber: | 8604438720 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/18/2009 | ||||||||
LastUpdateDate: | 04/08/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 082456 | CT | N |   | Nursing Service Providers | Registered Nurse |   | 163W00000X | FL9276479 | FL | N |   | Nursing Service Providers | Registered Nurse |   | 363LP0808X | 005378 | CT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
ID | Type | State | Issuer | Description | 008045785 | 05 | CT |   | MEDICAID |