1255444527 NPI number — MICHELLE L PURCARO MSN APRN

Table of content: MICHELLE L PURCARO MSN APRN (NPI 1255444527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255444527 NPI number — MICHELLE L PURCARO MSN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURCARO
Provider First Name:
MICHELLE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255444527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 CHASE PKWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-591-3077
Provider Business Mailing Address Fax Number:
203-591-3074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 CHASE PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-591-3077
Provider Business Practice Location Address Fax Number:
203-591-3074
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WX0200X , with the licence number:  E57760 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 002095 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3521911693003 . This is a "EMPLOYER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400002095CT01 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00422805400 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500028949 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002095 . This is a "STATE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V3630 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004228054 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 264072 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".




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