Provider Demographics
NPI:1104885565
Name:ESSTMAN, ELIZABETH B (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:ESSTMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 ABRAHMS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-3949
Mailing Address - Country:US
Mailing Address - Phone:860-523-3854
Mailing Address - Fax:860-523-3828
Practice Address - Street 1:1 ABRAHMS BLVD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-3949
Practice Address - Country:US
Practice Address - Phone:860-523-3854
Practice Address - Fax:860-523-3828
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE61373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004205151Medicaid
CT004205151Medicaid
P25702Medicare UPIN
CT500000767Medicare ID - Type Unspecified