Basic Information
| Provider Information | |||||||||
| NPI: | 1518979855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH- BASSETT | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
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| Practice Location | |||||||||
| Address1: | 74 PARK RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061191898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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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 | 363L00000X | 041299719 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | 209004736 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 000333 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 041299719 | 01 | IL | PROFESSIONAL NURSE LISCEN | OTHER | 209004736 | 01 | IL | ADVANCED PRACTICE NURSE | OTHER | 009003336 | 05 | CT | MEDICAID | 309002077 | 01 | IL | CONTROLLED SUBSTANCE | OTHER |