Provider Demographics
NPI:1447260385
Name:HWANG, NANCY (APRN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:MAILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:816 BROAD ST
Practice Address - Street 2:SUITE 24
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4350
Practice Address - Country:US
Practice Address - Phone:203-634-0086
Practice Address - Fax:203-237-6010
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS96387Medicare UPIN