Provider Demographics
NPI:1871769554
Name:BROGAN, LINDA A (APRN,CRNA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:BROGAN
Suffix:
Gender:F
Credentials:APRN,CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 PILGRIMS HBR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5448
Mailing Address - Country:US
Mailing Address - Phone:203-269-6334
Mailing Address - Fax:
Practice Address - Street 1:544 PILGRIMS HBR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5448
Practice Address - Country:US
Practice Address - Phone:203-641-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered