Basic Information
| Provider Information | |||||||||
| NPI: | 1376637009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | O'BRIEN | ||||||||
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| Credential: | APRN-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 DUDLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605297671 | ||||||||
| FaxNumber: | 8605297671 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 WOODLAND STREET | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607144801 | ||||||||
| FaxNumber: | 8607148073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 001956 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.