Individual
AMANDA DECEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
374 GRAND AVE, FAIR HAVEN COMMUNITY HEALTH CENTER, NEW HAVEN, CT 06513-3733
(203) 777-7411
Mailing address
374 GRAND AVE, FAIR HAVEN COMMUNITY HEALTH CENTER ATTN: HR, NEW HAVEN, CT 06513-3733
(203) 777-7411
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
98866
CT
363LF0000X
Family Nurse Practitioner
Primary
005069
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008042107
—
CT
Enumeration date
07/17/2012
Last updated
07/14/2016
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