Basic Information
| Provider Information | |||||||||
| NPI: | 1386892321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALRYMPLE | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LACEY RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064893711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065794945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 LAFAYETTE STREET | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602243642 | ||||||||
| FaxNumber: | 8602242760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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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 | 163W00000X | 097354 | CT | N | Nursing Service Providers | Registered Nurse | 163WC1500X | RN00174711 | WA | N | Nursing Service Providers | Registered Nurse | Community Health | 363LP0200X | 004572 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7407703 | 05 | WA | MEDICAID | 50-1839 | 01 | WA | MEDICARE FQHC | OTHER | 004236346 | 05 | CT | MEDICAID |