Provider Demographics
NPI:1548414667
Name:UCONN HEALTH CENTER, JOHN DEMPSEY HOSPITAL
Entity Type:Organization
Organization Name:UCONN HEALTH CENTER, JOHN DEMPSEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, ONCOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-679-7558
Mailing Address - Street 1:205 VERNON AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4365
Mailing Address - Country:US
Mailing Address - Phone:860-803-0706
Mailing Address - Fax:
Practice Address - Street 1:205 VERNON AVE APT 209
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4365
Practice Address - Country:US
Practice Address - Phone:860-803-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT957919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty