Healthcare Provider Details

I. General information

NPI: 1801183827
Provider Name (Legal Business Name): HENRY PUCIATO RN, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SAMSON ROCK DR
MADISON CT
06443-3018
US

IV. Provider business mailing address

7 BROAD HILL CIR
GUILFORD CT
06437-1722
US

V. Phone/Fax

Practice location:
  • Phone: 203-868-6201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4697
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number075149
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: