Provider Demographics
NPI:1295169589
Name:CITY OF HARTFORD HARTFORD PUBLIC SCHOOLS
Entity type:Organization
Organization Name:CITY OF HARTFORD HARTFORD PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-695-8000
Mailing Address - Street 1:25 TIMOTHY TER
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1653
Mailing Address - Country:US
Mailing Address - Phone:860-219-0336
Mailing Address - Fax:
Practice Address - Street 1:960 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1224
Practice Address - Country:US
Practice Address - Phone:860-695-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363FL0000X261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health