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Individual

TANYA THERIAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
85 LAFAYETTE STREET, NEW BRITAIN, CT 06052
(860) 224-3642
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
98997
CT
363LF0000X
Family Nurse Practitioner
Primary
005103
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004236346
CT
Enumeration date
07/27/2012
Last updated
10/22/2012
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