Healthcare Provider Details

I. General information

NPI: 1730435355
Provider Name (Legal Business Name): NICOLE MARIE FERRETTI APRN, RN, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510
US

IV. Provider business mailing address

15 ORANGE ST APT 217
NEW HAVEN CT
06510-3344
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-5010
  • Fax:
Mailing address:
  • Phone: 203-509-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001071
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number127698
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number7767
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: