Provider Demographics
NPI:1811642309
Name:NURSE PRACTITIONERS GERONTOLOGY GROUP PLLC
Entity type:Organization
Organization Name:NURSE PRACTITIONERS GERONTOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:CHENA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-212-2896
Mailing Address - Street 1:1 REGENCY DR STE 309
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2310
Mailing Address - Country:US
Mailing Address - Phone:860-836-2383
Mailing Address - Fax:
Practice Address - Street 1:1 REGENCY DR STE 309
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2310
Practice Address - Country:US
Practice Address - Phone:860-836-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty