Healthcare Provider Details

I. General information

NPI: 1184518953
Provider Name (Legal Business Name): MARY A PLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST # E2006
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

56 FRENCH AVE
EAST HAVEN CT
06512-3314
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3538
  • Fax: 203-867-5461
Mailing address:
  • Phone: 203-909-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106798
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14941
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: