Individual
ELIZABETH MAGENHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP APRN
Contact information
Practice address
374 GRAND AVENUE, FAIR HAVEN COMMUNITY HEALTH CTR, NEW HAVEN, CT 06513
(203) 777-7411
(203) 777-8506
Mailing address
120 HUNTINGTON STREET, NEW HAVEN, CT 06511
(203) 787-1383
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
000756
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
183832
WELLCARE
—
01
—
756000
CT CARE
—
Enumeration date
09/11/2006
Last updated
07/08/2007
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