Doctor Name: | MRS. NICOLE EDDY ORTIZ |
NPI Number: | 1245644954 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, APRN, FNP-BC |
License Number: | 5728 |
Business Practice Address: | 80 Norwich New London Tpke Uncasville, CT - 063822527 |
Business Phone Number: | 8608481297 |
Business Fax Number: | |
Mailing Address: | 326 Washington St, NORWICH |
State: | CT |
Postal Code: | 063602740 |
Phone Number: | 8608898331 |
Fax Number: | |
NPI Enumeration Date: | 06/20/2014 |
NPI Last Update Date: | 06/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5728 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |