Healthcare Provider Details

I. General information

NPI: 1083223903
Provider Name (Legal Business Name): VICTORIA PIACQUADIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA WISCHHUSEN

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

2 TRAP FALLS RD STE 414
SHELTON CT
06484-7621
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-5663
  • Fax:
Mailing address:
  • Phone: 203-929-7353
  • Fax: 203-929-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number112500
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: