Provider Demographics
NPI:1619567260
Name:INNOVATIVE HEALTHCARE OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMYLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAHENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, NP-C
Authorized Official - Phone:860-985-6259
Mailing Address - Street 1:836 FARMINGTON AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1545
Mailing Address - Country:US
Mailing Address - Phone:860-328-6147
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 219
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1545
Practice Address - Country:US
Practice Address - Phone:860-328-6147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty