NPI 1114150984 · live from the CMS NPI Registry
Danil Anisimov
Nurse Practitioner, Psych/Mental Health in Old Saybrook, CT. National Provider Identifier 1114150984, active.
NPI record
| NPI | 1114150984 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Psych/Mental Health 363LP0808X |
| Practice location | 20 Research Pkwy, Old Saybrook, CT 06475 |
| Practice phone | 800-370-3651 |
| Mailing address | 31 Richards Grove Rd, Quaker Hill, CT 06375 |
| Enumerated | August 27, 2009 |
| Last updated | April 28, 2017 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Family | 363LF0000X | 4165 (CT) |
| Nurse Practitioner, Psych/Mental Health primary | 363LP0808X | 4165 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.