Basic Information
| Provider Information | |||||||||
| NPI: | 1760810972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINUTE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 CROMWELL AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060671801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663892727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 323 CROMWELL AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060671801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1866389272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | AGYEKUM | ||||||||
| AuthorizedOfficialFirstName: | KARREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 18663892727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MINUTE CLINIC | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5531 | CT | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.