Provider Demographics
NPI:1487195863
Name:DOUGLAS-SAUNDERS, NAOMI (APRN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:DOUGLAS-SAUNDERS
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 1:25 OAKLAND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2897
Mailing Address - Country:US
Mailing Address - Phone:860-644-9578
Mailing Address - Fax:
Practice Address - Street 1:25 OAKLAND RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2897
Practice Address - Country:US
Practice Address - Phone:860-644-9578
Practice Address - Fax:860-648-1107
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61765163WM0705X
CT6839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical