1285982363 NPI number — BRENDA CAROLINA WHITE APRN

Table of content: BRENDA CAROLINA WHITE APRN (NPI 1285982363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285982363 NPI number — BRENDA CAROLINA WHITE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
BRENDA
Provider Middle Name:
CAROLINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JARAMILLO
Provider Other First Name:
BRENDA
Provider Other Middle Name:
CAROLINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285982363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 415933
Provider Second Line Business Mailing Address:
HARTFORD HOSPITAL PROFESSIONAL SERVICES
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-972-9047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
HARTFORD HOSPITAL SURGERY DEPT
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-972-4670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  005098 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2100X , with the licence number: 005098 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004050985 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".