1104106871 NPI number — LEEANNE LACHAPELLE A.P.R.N

Table of content: LEEANNE LACHAPELLE A.P.R.N (NPI 1104106871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104106871 NPI number — LEEANNE LACHAPELLE A.P.R.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACHAPELLE
Provider First Name:
LEEANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.P.R.N
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104106871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ENTERPRISE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-377-2272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2011

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: 363LA2200X , with the licence number:  004757 , 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: D400060357 . This is a "MC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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