Basic Information
| Provider Information | |||||||||
| NPI: | 1598283574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGLENNON | ||||||||
| FirstName: | MAUREEN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 PARK ST | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066144052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039935889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032004363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2017 | ||||||||
| LastUpdateDate: | 12/04/2017 | ||||||||
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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 | 363LF0000X | 7202 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207RH0000X | 7202 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No ID Information.