Provider Demographics
NPI:1861455073
Name:MANDEL, ELIZABETH A (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:A
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, CNM
Mailing Address - Street 1:PO BOX 40,000 DEPT 634
Mailing Address - Street 2:HARTFORD HOSPITAL PROFESSIONAL SERVICES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06151-0634
Mailing Address - Country:US
Mailing Address - Phone:860-545-7602
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:HARTFORD HOSPITAL OB/GYN DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-5037
Practice Address - Country:US
Practice Address - Phone:860-545-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000226367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CT004223418Medicaid
CT004223418Medicaid
CTMEDICARE - C00814Medicare PIN
E41782Medicare UPIN
CTPENDING - C00023Medicare PIN