1376885657 NPI number — MS. JACQUELINE MARIE ARENA-ROBERTS APRN, CRNA

Table of content: MS. JACQUELINE MARIE ARENA-ROBERTS APRN, CRNA (NPI 1376885657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376885657 NPI number — MS. JACQUELINE MARIE ARENA-ROBERTS APRN, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARENA-ROBERTS
Provider First Name:
JACQUELINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOMBROWSKI
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376885657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 E RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-3288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-282-4133
Provider Business Mailing Address Fax Number:
860-289-0742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-2117
Provider Business Practice Location Address Fax Number:
860-545-1784
Provider Enumeration Date:
03/25/2013

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: 367500000X , with the licence number:  5387 , 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)





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