Healthcare Provider Details

I. General information

NPI: 1558364174
Provider Name (Legal Business Name): MARIA L ZANDONELLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PEPPERBUSH DR
CLINTON CT
06413-1168
US

IV. Provider business mailing address

17 PEPPERBUSH DR
CLINTON CT
06413-1168
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-5302
  • Fax:
Mailing address:
  • Phone: 860-669-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002961
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: