Provider Demographics
NPI:1447481981
Name:HEPNER, AUBREY A (APRN)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:A
Last Name:HEPNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:A
Other - Last Name:WAYNELOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT OFFICE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:CRITICAL CARE MEDICINE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2200
Practice Address - Country:US
Practice Address - Phone:860-679-3107
Practice Address - Fax:860-679-1843
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1447481981Medicaid