Provider Demographics
NPI:1508313933
Name:HUMMINGBIRD TRAUMA RESOLUTION, LLC
Entity Type:Organization
Organization Name:HUMMINGBIRD TRAUMA RESOLUTION, LLC
Other - Org Name:HUMMINGBIRD TRAUMA RESOLUTION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ROBINS
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, SE
Authorized Official - Phone:203-824-1249
Mailing Address - Street 1:635 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1127
Mailing Address - Country:US
Mailing Address - Phone:203-440-9288
Mailing Address - Fax:203-440-9288
Practice Address - Street 1:635 FOXON RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1127
Practice Address - Country:US
Practice Address - Phone:203-440-9288
Practice Address - Fax:203-440-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000440363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty