Basic Information
| Provider Information | |||||||||
| NPI: | 1346213006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | DIANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSN APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 GRAND STREET | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605507500 | ||||||||
| FaxNumber: | 8605507501 | ||||||||
| Practice Location | |||||||||
| Address1: | 282 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459300 | ||||||||
| FaxNumber: | 8605459301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | R40359 | CT | X | Nursing Service Providers | Registered Nurse | Pediatrics | 364SP0200X | 001483 | CT | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001483 | 01 | CT | APRN | OTHER | R40359 | 01 | CT | RN LICENSE | OTHER |