Healthcare Provider Details

I. General information

NPI: 1366159352
Provider Name (Legal Business Name): ASHLEY PEDNEAULT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 FARMINGTON AVE
FARMINGTON CT
06032-2381
US

IV. Provider business mailing address

74 SCHALLER RD
MANCHESTER CT
06042-2849
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11162
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: