Individual
MS. ELISABETH A REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
E46044
CT
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
000590
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004184694
—
CT
01
—
061470493
FIRST CHOICE
—
01
—
095000
CONNECTICARE
—
01
—
400000590CT01
BCBS MAP
—
01
—
OV9806
PHS
—
Enumeration date
09/07/2006
Last updated
07/23/2013
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