Provider Demographics
NPI:1679519375
Name:HARRELL, CISALEE GENE (APRN)
Entity type:Individual
Prefix:MS
First Name:CISALEE
Middle Name:GENE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CISALEE
Other - Middle Name:GENE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:62 W EGGLESTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3249
Mailing Address - Country:US
Mailing Address - Phone:860-667-6255
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-667-6255
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000191OtherAPRN