1912911793 NPI number — MRS. KAREN M PETRUNEY APRN

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912911793 NPI number — MRS. KAREN M PETRUNEY APRN

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PETRUNEY

Provider First Name:

KAREN

Provider Middle Name:

M

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

APRN

Provider Gender Code:

F

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:

1912911793

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/30/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2141 TWENTY MILE STREAM RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PROCTORSVILLE

Provider Business Mailing Address State Name:

VT

Provider Business Mailing Address Postal Code:

05153-9716

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-819-2121

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

38 ROUTE 11

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LONDONDERRY

Provider Business Practice Location Address State Name:

VT

Provider Business Practice Location Address Postal Code:

05148-9555

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

802-824-6901

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363L00000X , with the licence number:  001905 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3V5927 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 22-77593 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 004254314 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 7681206 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 180092 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 400001905CT01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P4231031 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 1143111 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 740168 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: PENDING . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".