Healthcare Provider Details

I. General information

NPI: 1558550517
Provider Name (Legal Business Name): MARIANNE TREANTAFILOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MILESTONE RD.
DANBURY CT
06810
US

IV. Provider business mailing address

30 MILESTONE ROAD
DANBURY CT
06810-5103
US

V. Phone/Fax

Practice location:
  • Phone: 203-702-7400
  • Fax: 203-702-7401
Mailing address:
  • Phone: 203-702-7400
  • Fax: 203-702-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003641
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: