Provider Demographics
NPI:1164730032
Name:PADYKULA, BOZENA MARIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BOZENA
Middle Name:MARIA
Last Name:PADYKULA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SOUTH SLOPE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:860-828-4043
Mailing Address - Fax:860-828-4043
Practice Address - Street 1:87 SOUTH SLOPE DRIVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:860-828-4043
Practice Address - Fax:860-828-4043
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004373363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health