Provider Demographics
NPI:1083178446
Name:MCPHERSON, CHENA ANGELA (APRN)
Entity Type:Individual
Prefix:
First Name:CHENA
Middle Name:ANGELA
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHENA
Other - Middle Name:ANGELA
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:994 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1940
Mailing Address - Country:US
Mailing Address - Phone:860-212-2896
Mailing Address - Fax:
Practice Address - Street 1:1 REGENCY DR STE 309
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2310
Practice Address - Country:US
Practice Address - Phone:860-836-2383
Practice Address - Fax:860-206-5499
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008031363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400831863Medicaid