1790899680 NPI number — MICHELLE MURRAY GLIDDEN APRN

Table of content: MICHELLE MURRAY GLIDDEN APRN (NPI 1790899680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790899680 NPI number — MICHELLE MURRAY GLIDDEN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLIDDEN
Provider First Name:
MICHELLE
Provider Middle Name:
MURRAY
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:
MURRAY
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
MARIE
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:
1790899680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASYLUM AVE
Provider Second Line Business Mailing Address:
SUITE 2109A
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-6581
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 WOODLAND ST
Provider Second Line Business Practice Location Address:
CARDIOLOGY
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-4202
Provider Business Practice Location Address Fax Number:
860-714-8001
Provider Enumeration Date:
08/18/2006

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:  3226 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 400003226CT . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 032260 . This is a "CT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004251170 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V6522 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00425117000 . This is a "EDS BLUE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3605515 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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