NPI 1679012751 · live from the CMS NPI Registry
Amanda Marie Antonino, APRN
Nurse Practitioner, Adult Health in Bozrah, CT. National Provider Identifier 1679012751, active.
NPI record
| NPI | 1679012751 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Adult Health 363LA2200X |
| Practice location | 197 Fitchville Rd, Apt 5, Bozrah, CT 06334 |
| Practice phone | 186-028-7270 |
| Enumerated | February 22, 2017 |
| Last updated | February 22, 2017 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Adult Health primary | 363LA2200X | 6802 (CT) |
| Nurse Practitioner, Gerontology | 363LG0600X | 6802 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.