Provider Demographics
NPI:1790769107
Name:GO, MARIA ANNA M (APRN)
Entity Type:Individual
Prefix:
First Name:MARIA ANNA
Middle Name:M
Last Name:GO
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:130 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3440
Mailing Address - Country:US
Mailing Address - Phone:203-272-7909
Mailing Address - Fax:
Practice Address - Street 1:EVERCARE
Practice Address - Street 2:450 COLUMBUS AVENUE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-6270
Practice Address - Country:US
Practice Address - Phone:860-874-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003310363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004253895Medicaid