Provider Demographics
NPI:1689421604
Name:EGAN, CAROL A
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:EGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HUYSHOPE AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2873
Mailing Address - Country:US
Mailing Address - Phone:860-836-1990
Mailing Address - Fax:
Practice Address - Street 1:140 HUYSHOPE AVE APT 315
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2873
Practice Address - Country:US
Practice Address - Phone:860-836-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT71400000XOtherCHHC