Healthcare Provider Details

I. General information

NPI: 1356711311
Provider Name (Legal Business Name): ASSUNTA DELUCA-BACHMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST SUITE 202B
MONROE CT
06468-2280
US

IV. Provider business mailing address

42 RUELA DR
NAUGATUCK CT
06770-3307
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5535
  • Fax: 203-907-1234
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6278
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: