Jackson, Elizabeth Detweiler

Jackson, Elizabeth Detweiler is an individual health care provider with primary practice located at 42 Town St Ste 300 , Norwich CT 06360-2339. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Jackson, Elizabeth Detweiler can be contacted via phone (860) 886-0567.

Contact Information

Primary practice address
42 Town St Ste 300 Norwich CT 06360-2339
Phone: (860) 886-0567
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 132311 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 009070 Connecticut

Profile Details

NPI number 1902420466
LBN Legal business name Jackson, Elizabeth Detweiler
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2020
Last updated Aug 3rd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902420466 NPPES
Connecticut Other 009070 CT LIC

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