Provider Demographics
NPI:1609064054
Name:FORD, DONNA (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FORD
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6200
Mailing Address - Fax:860-224-6260
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-348-4242
Practice Address - Fax:860-348-4646
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT423198OtherWELLCARE MEDICARE
CT103681OtherCONNECTICARE
CT400003681CT01OtherBCBS NEW BRITAIN OFFICE
CT400003681CT02OtherBCBS CROMWELL OFFICE
CT004272283Medicaid
CT400003681CT02OtherBCBS CROMWELL OFFICE