Individual
ELIZABETH DAVOREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3 PROSPECT ST, VERNON, CT 06066-3125
(860) 896-1616
Mailing address
3 PROSPECT ST, VERNON, CT 06066-3125
(860) 896-1616
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
002950
CT
363LF0000X
Family Nurse Practitioner
Primary
002950
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
07/11/2005
Last updated
10/05/2009
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