Basic Information
| Provider Information | |||||||||
| NPI: | 1629475371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINDHAM COMMUNITY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4131 | ||||||||
| Address2: | |||||||||
| City: | YALESVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032841340 | ||||||||
| FaxNumber: | 2032654557 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 MANSFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604566752 | ||||||||
| FaxNumber: | 2032654557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 11/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | MACKIE | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8604258755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
No ID Information.