Healthcare Provider Details

I. General information

NPI: 1548784796
Provider Name (Legal Business Name): MICHELE PALMUCCI BARRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE ANN PALMUCCI

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MASONIC AVE STE 2400
WALLINGFORD CT
06492-3095
US

IV. Provider business mailing address

2304 ELLINGTON RD
SOUTH WINDSOR CT
06074-2148
US

V. Phone/Fax

Practice location:
  • Phone: 203-626-9080
  • Fax:
Mailing address:
  • Phone: 203-804-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7086
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: