Healthcare Provider Details

I. General information

NPI: 1891705307
Provider Name (Legal Business Name): MARY ELIZABETH SCHUSTEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH DOOLITTLE APRN

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MASONIC AVE SUITE 3100
WALLINGFORD CT
06492-3095
US

IV. Provider business mailing address

67 MASONIC AVE SUITE 3100
WALLINGFORD CT
06492-3095
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-3144
  • Fax: 203-284-3140
Mailing address:
  • Phone: 203-284-3144
  • Fax: 203-284-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN2742
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number006357
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2742
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: