1801293824 NPI number — MRS. TANYA R BASSETT DNP, MHPNP

Table of content: MRS. TANYA R BASSETT DNP, MHPNP (NPI 1801293824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801293824 NPI number — MRS. TANYA R BASSETT DNP, MHPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASSETT
Provider First Name:
TANYA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, MHPNP
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:
1801293824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 ALBION ST
Provider Second Line Business Mailing Address:
SOUTHWEST COMMUNITY HEALTH
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06605-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-330-6000
Provider Business Mailing Address Fax Number:
203-330-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 ALBION ST
Provider Second Line Business Practice Location Address:
SOUTHWEST COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06605-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-330-6000
Provider Business Practice Location Address Fax Number:
203-330-6010
Provider Enumeration Date:
11/20/2014

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: 363LP0808X , with the licence number:  1801293824 , 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: 005987 . This is a "CONNECTICUT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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