Healthcare Provider Details

I. General information

NPI: 1679850408
Provider Name (Legal Business Name): PAMELA M CIPRIANO DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST SUITE 101A
THOMASTON CT
06787-1747
US

IV. Provider business mailing address

131 MAIN ST SUITE 101A
THOMASTON CT
06787-1747
US

V. Phone/Fax

Practice location:
  • Phone: 860-880-2525
  • Fax: 860-880-8253
Mailing address:
  • Phone: 860-880-2525
  • Fax: 860-880-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number004854
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number004854
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: